Get Form Dfs K4 1055

Filling out the Form Dfs K4 1055 online is an essential process for notifying the Bureau of Fire Standards & Training about a firefighter's ineligibility for supplemental compensation. This guide will provide you with clear and step-by-step instructions to complete the form efficiently.

Follow the steps to complete the Form Dfs K4 1055 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the firefighter. Provide their last name, first name, and middle initial. Include the maiden name if applicable.
3. Next, input the home address of the firefighter, including the city, state, and ZIP code.
4. Enter the firefighter's telephone number for further communication.
5. Provide the name of the fire department where the firefighter is or was employed.
6. Indicate the name of the fire chief or authorized agent responsible for signing the form.
7. Complete the department mailing address, including city, state, and ZIP code.
8. Select the appropriate reason for the change in eligibility status from the options provided.
9. Enter the date of ineligibility, making sure to input the first day of ineligibility and not the last working day.
10. Ensure that the fire chief or authorized agent signs the form and includes the date of signature.
11. Review all entered information for accuracy, then save the changes before downloading or printing the completed form.
12. Once finalized, submit the form to the Bureau of Fire Standards & Training within ten business days as required.

Complete your Form Dfs K4 1055 online today and ensure timely submission!