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This document provides a worksheet and instructions for employers to claim refunds on workers’ compensation operations fund surcharge payments made between July 1, 2003, and June 30, 2009.
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How to fill out workers compensation operations fund
How to fill out Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet
01
Obtain the Workers' Compensation Operations Fund Surcharge Refund Claim Worksheet from the appropriate source.
02
Fill out your personal information at the top of the worksheet, including name, address, and contact details.
03
Identify the period for which you are claiming a refund by entering the relevant dates.
04
Calculate the total amount of surcharge paid, ensuring to include any relevant documentation for verification.
05
Complete the section detailing the reasons for the refund claim, providing clear explanations.
06
Sign and date the completed worksheet to certify that the information provided is accurate.
07
Submit the completed claim worksheet along with any necessary documentation to the appropriate authority.
Who needs Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet?
01
Any employer or business that has paid into the Workers' Compensation Operations Fund and believes they are eligible for a refund due to overpayment or changes in their claim status.
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What is Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet?
The Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet is a form used to request a refund of surcharge payments made to the Workers’ Compensation Operations Fund, typically applied to businesses that have overpaid or are eligible for a refund.
Who is required to file Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet?
Employers or businesses that have made surcharge payments to the Workers’ Compensation Operations Fund and believe they are eligible for a refund must file the worksheet.
How to fill out Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet?
To fill out the Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet, gather necessary financial documentation, accurately enter your business information, specify the amount of surcharge paid, and provide any required signatures along with submission to the appropriate governing authority.
What is the purpose of Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet?
The purpose of the Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet is to facilitate the process for eligible businesses to reclaim overpayments or excess surcharge fees that were initially paid to support the Workers’ Compensation Operations Fund.
What information must be reported on Workers’ Compensation Operations Fund Surcharge Refund Claim Worksheet?
The information that must be reported includes the business's name and address, the amount of surcharge paid, specific reasons for the refund request, relevant account numbers, and any additional documentation that supports the claim.
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