Get State Of Ga Board Rule 102b Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the State Of Ga Board Rule 102b Form online
Filling out the State Of Ga Board Rule 102b Form online can be a straightforward process with the right guidance. This guide provides detailed instructions to help you correctly complete the form, ensuring all necessary information is included.
Follow the steps to accurately fill out the form online.
- Press the ‘Get Form’ button to access the State Of Ga Board Rule 102b Form and open it in your online editor.
- Provide your identifying information in the designated sections, including your last name, first name, middle initial, and social security number.
- Input the date of injury and fill out the employer's details, including the name, address, phone number, and the county where the injury occurred.
- Enter the employee's contact information, including their address, city, state, zip code, and email.
- Fill in the insurer or self-insurer details, providing their name, contact details, and email address.
- Complete the claims office information, including the claims office name, address, phone number, and email.
- Indicate if an MSA (Medicare Set-Aside) is involved and specify whether the claim is designated as a catastrophic injury.
- Confirm if the claim has been accepted by the Subsequent Injury Trust Fund (SITF).
- Review the certification area to ensure all parties agree to participate in mediation; check the appropriate boxes as necessary.
- If applicable, specify the existence of a valid fee contract or previous submission of Form WC 102B.
- Complete the certificate of service section by certifying that you have sent copies of the form to all relevant parties and the State Board of Workers' Compensation.
- Finally, provide signatures, dates, and email addresses for the employee representative and the employer/insurer representative.
Complete your document online today for a hassle-free submission.
When starting a new job, two essential forms are typically required: the W-4 form and the I-9 form. However, in Georgia, the State Of Ga Board Rule 102b Form is also critical for compliance with state-specific regulations. The W-4 informs the employer of your tax withholding preferences, while the I-9 verifies your identity and eligibility to work legally. Completing these forms ensures that your employment process starts on the right foot.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.