Reopened Claims Program Reimbursement Request Forms
| Form Name | Reopened Claims Program Reimbursement Request |
| Form # | 440-1966 |
| Form Revision | 2/16 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | Insurer's or self-insured employer's quarterly request for reimbursement from the Reopened Claims Program, part of the Workers' Benefit Fund. |
| Claimwire Description | n/a |