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ACTION: OriginalDATE: 05/25/2007 11:55 AMRule Summary and Fiscal Analysis (Part A) Bureau of Workers\' Compensation Agency NameTom Sico DivisionContact30 West Spring St. L26 Columbus OH 43215000061446666006144669384Agency
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The 4123-19-03 amendment refers to a specific form or filing related to workers' compensation in Ohio that allows employers to amend their previous claims or records.
Employers who need to update or correct information regarding their workers' compensation claims or who need to report changes in their employee status are required to file the 4123-19-03 amendment.
To fill out the 4123-19-03 amendment, employers must provide accurate and complete information as requested on the form, including details about the employee involved, the nature of the amendment, and relevant dates.
The purpose of the 4123-19-03 amendment is to ensure that accurate records are maintained for workers' compensation claims, facilitating proper management and adjustment of claims and benefits.
The information that must be reported includes the employer's details, employee’s details, description of the amendment, dates of the incident or action, and any relevant supporting documentation.
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