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Please TYPE or PRINT IN INK Rev. 1252016State of Connecticut Workers Compensation Commission WCC File #Notice of Claim for Compensation30CDate filed in District(Employee to Commissioner and to Employer)This
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Obtain the necessary forms or documents from the appropriate government agency.
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Employers or organizations that need to appoint a commissioner for their employees.
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Employee to commissioner and is a report that employers must submit to the commissioner providing information about their employees.
Employers are required to file employee to commissioner and.
Employee to commissioner and can be filled out online or through paper forms provided by the commissioner.
The purpose of employee to commissioner and is to provide accurate information about employees for tax and other purposes.
Information such as employee's name, social security number, wages, and taxes withheld must be reported on employee to commissioner and.
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