This form is an official Pennsylvania's Worker's Compensation form which complies with all applicable state codes and statutes. USLF updates all state forms as is required by state statutes and law.
This form is an official Pennsylvania's Worker's Compensation form which complies with all applicable state codes and statutes. USLF updates all state forms as is required by state statutes and law.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
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