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Ll portions of this form package must be completed to avoid undue delay in processing claimant's request for benefits. NOTICE OF CLAIM - Employer Instructions Complete the following when an employee will be out of work longer than the STD elimination period: A. Complete the Employer's Report of Claim in full; B. Give claim form to claimant for completion; and C. Request copy of awards from other sources of benefits: Social Security, Workers' Compensation, retirement, state disability, and other.

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