State Fund Employer's Agreement to Accept Claim Assignment Forms
| Form Name | State Fund Employer's Agreement to Accept Claim Assignment |
| Form # | BWC-1395 C-263 |
| Form Revision | (Rev. April 23, 2024) |
| Category | Forms » Board/Commission/Division |
| Downloads | |
| Form State | Ohio |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |