Get State Of California Division Of Workers Compensation Retraining And Return To Work Unit Form

Filling out the State of California Division of Workers Compensation Retraining and Return To Work Unit Form online is a crucial step in accessing your supplemental job displacement benefits. This guide aims to provide you with clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Complete the 'Injured Employee' section by providing your first name, middle initial, last name, address or P.O. box, city, state, zip code, date of birth, case number, and phone number. Ensure that all fields are filled out completely.
3. In the 'Claims Administrator' section, fill in the claims administrator's name, mailing address, city, state, zip code, and phone number. This information is mandatory for your application to be processed.
4. If applicable, provide details of your vocational return to work counselor. Fill in the necessary fields, including their first name, last name, address, city, state, zip code, phone number, and the funds used for counseling.
5. Attach additional pages if you are using more than one training provider. In this section, provide the first name and last name of the training provider, along with their address, city, state, zip code, phone number, expiration date, provider approval number, contact name, and training cost.
6. Ensure you sign and date the voucher form on the specified line to confirm the information provided is accurate.
7. After completing all sections, review the form for accuracy. Once confirmed, you can save changes, download, print, or share the form as needed.

Complete your documents online today for prompt access to your benefits.