Document
Request for State or Federal Workers Compensation
ICR 201911-1240-002 · OMB 1240-0032 · Object 96519601.
This document may belong to an older filing. More recent activity for OMB 1240-0032:
Document Viewer [docx]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-06-13 00:08:30)
Missing: html
Download: Source copy (docx)
Loading document viewer…
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Request for State or Federal Workers Compensation |
| Author | Debbie Thurston |
| File Created | 2021-01-15 |
| Conversion State | partial |