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BEFORE THE WORKERS\' COMPENSATION BOARD STATE OF OREGON In the Matter of the Compensation ofGERALD K. BURLAGE, Claimant) ) ) ) ) )WCB Case No. 9804988 Claim No. 7856347H DOI: 03/23/98 WCD File No.
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How to fill out di 52120205 oregon workers
How to fill out di 52120205 oregon workers
01
Obtain the DI 52120205 form from the Oregon Workers' Compensation Division website or your employer.
02
Read the instructions provided on the form carefully.
03
Fill out the employee information section, including your name, address, and Social Security number.
04
Provide information about your employer, including their name and address.
05
Indicate the date of your injury or illness.
06
Describe the nature of your injury or illness in detail.
07
Complete the section regarding your work status at the time of the injury.
08
Sign and date the form to certify that the information provided is accurate.
09
Submit the completed form to your employer for them to forward to the insurance carrier.
Who needs di 52120205 oregon workers?
01
Employees who have sustained an injury or illness related to their work in Oregon.
02
Employers who are required to complete the form as part of the workers' compensation claim process.
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What is di 52120205 oregon workers?
DI 52120205 is a specific form used by workers in Oregon to report their wage and employment information for various purposes, including eligibility for benefits.
Who is required to file di 52120205 oregon workers?
Employers in Oregon are required to file DI 52120205 for their employees to report wages and employment status for unemployment insurance purposes.
How to fill out di 52120205 oregon workers?
To fill out DI 52120205, provide accurate employee details, including name, Social Security number, wages, and the period of employment. Follow the instructions provided with the form.
What is the purpose of di 52120205 oregon workers?
The purpose of DI 52120205 is to collect information on workers' earnings and employment status to assess their eligibility for unemployment benefits and other state programs.
What information must be reported on di 52120205 oregon workers?
Information that must be reported includes the employee’s name, Social Security number, total wages earned, and the period of employment.
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