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Get Instructions To Complete Form Dwc Wcab Form 1a

STATE OF CALIFORNIA DIVISION OF WORKERS COMPENSATION WORKERS COMPENSATION APPEALS BOARD APPLICATION FOR ADJUDICATION OF CLAIM Print Form Reset Form Amended Application Case No. SSN Numbers Only Venue choice is based upon Completion of this section is required County of residence of employee Labor Code section 5501. 5 a 1 or d. County where injury occurred Labor Code section 5501. 5 a 2 or d. County of principal place of business of employee s att.

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