AFFIDAVIT OF INDIGENCE AND REQUEST FOR WAIVER OF 11A(2) FEES Forms
| Form Name | AFFIDAVIT OF INDIGENCE AND REQUEST FOR WAIVER OF 11A(2) FEES |
| Form # | Form 136 |
| Form Revision | Revised 7/2019 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Massachusetts |
| Language | English |
| State Description | This form is used to waive the $ 450 Appeal of Conference fee. The fee goes toward paying the Impartial Medical Examiner assigned by the Department of Industrial Accidents and the subsequent report. |
| Claimwire Description | n/a |