CARRIER’S NOTIFICATION OF SCHEDULED INJURY TIME LOSS IN EXCESS OF 90 DAYS Forms
| Form Name | CARRIER’S NOTIFICATION OF SCHEDULED INJURY TIME LOSS IN EXCESS OF 90 DAYS |
| Form # | SpecFund ICA 5525 |
| Form Revision | Rev 03.21.25 |
| Category | Forms » Special Fund |
| Downloads | |
| Form State | Arizona |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |