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How to fill out de2501fc
How to fill out de2501fc
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Step 1: Obtain a DE 2501FC form from your employer or workers' compensation carrier.
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Step 2: Fill in your personal information, such as your name, address, and Social Security number.
03
Step 3: Provide details about your employer, such as the company name and address.
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Step 4: Indicate the date of your injury or illness and provide a detailed description of what happened.
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Step 5: If you received any medical treatment, include the names and addresses of the medical providers.
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Step 6: Attach any relevant medical reports or receipts for expenses related to your injury or illness.
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Step 7: Sign and date the form.
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Step 8: Make a copy of the completed form for your records before submitting it to your employer or workers' compensation carrier.
Who needs de2501fc?
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DE 2501FC is needed by employees who have sustained a work-related injury or illness and wish to file a workers' compensation claim.
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