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Form OICWC202×West Virginia Workers CompensationApplication for 104 Weeks Dependents Benefits In all claims for compensation, except occupational pneumoconiosis or other occupational diseases, the
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Application for 104 weeks is a form that allows individuals to apply for financial assistance or benefits for a period of 104 weeks.
Individuals who meet certain eligibility requirements are required to file application for 104 weeks in order to receive financial assistance or benefits.
To fill out application for 104 weeks, individuals need to provide personal information, details of their financial situation, and any other required documentation as specified in the form.
The purpose of application for 104 weeks is to help individuals in need of financial support for a period of 104 weeks.
Information such as personal details, financial status, employment history, and any other relevant information must be reported on application for 104 weeks.
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