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Instructions If you missed time from work because of injuries sustained in the accident, and you intend to file a claim for medical or wage loss expenses, you must have your employer complete the

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What is you will need to?

You will need to provide all required information and documentation.

Who is required to file you will need to?

Individuals or entities specified by the governing body are required to file.

How to fill out you will need to?

You can fill out the document online or by mail using the provided form.

What is the purpose of you will need to?

The purpose of the form is to report necessary information to the appropriate authorities.

What information must be reported on you will need to?

You must report income, expenses, and any other relevant financial information.

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