
DC PSWCP Form 9-A 2017 free printable template
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47 i Appeal of award calculation and certification or Other. TURN OVER FOR MORE INSTRUCTIONS 441 Fourth Street NW Suite 800 South Washington DC 20001 Tel 202 727-8600 http //orm.dc.gov/ PSWCP Form 9-A Rev 07/2017 District of Columbia Government Page 1 of 2 Reason for Disagreement with Program Decision You MUST answer all of the following questions. Please submit with this form a copy of the PSWCP Decision and any necessary attachments. This request excluding supporting documentation...
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How to fill out DC PSWCP Form 9-A

How to fill out DC PSWCP Form 9-A
01
Obtain a copy of the DC PSWCP Form 9-A from the relevant authority or website.
02
Fill out your personal information, including name, address, and contact details, in the designated sections.
03
Provide information regarding your employment history and the specific incident that led to the claim.
04
Gather and attach any necessary documentation that supports your claim, such as medical records or incident reports.
05
Review the entire form for accuracy and completeness.
06
Sign and date the form at the bottom as required.
07
Submit the completed form to the appropriate office or mailing address.
Who needs DC PSWCP Form 9-A?
01
Individuals who are filing a claim related to a work-related injury or illness under the DC Public Sector Workers' Compensation Program.
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What is DC PSWCP Form 9-A?
DC PSWCP Form 9-A is a specific form used in the District of Columbia for reporting workers' compensation claims and related information in the Public Sector Workers' Compensation Program.
Who is required to file DC PSWCP Form 9-A?
Employers in the District of Columbia who are participating in the Public Sector Workers' Compensation Program and have employees who have suffered work-related injuries or illnesses are required to file DC PSWCP Form 9-A.
How to fill out DC PSWCP Form 9-A?
To fill out DC PSWCP Form 9-A, employers must provide detailed information about the employee's injury or illness, including the nature of the injury, the date it occurred, medical treatment received, and any other relevant details as specified in the form's instructions.
What is the purpose of DC PSWCP Form 9-A?
The purpose of DC PSWCP Form 9-A is to document and report workers' compensation claims within the District of Columbia, ensuring compliance with laws and regulations governing workers' compensation for public sector employees.
What information must be reported on DC PSWCP Form 9-A?
The information that must be reported on DC PSWCP Form 9-A includes employee details, the date and circumstances of the injury or illness, medical treatment provided, and any relevant documentation that supports the claim.
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