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 120 State Forms found

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REQUEST FOR INVESTIGATION (Spanish)

 LB-3304s (REV 05/22)

REQUEST FOR SETTLEMENT APPROVAL – FORM RSA

 LB-0932 (Revised 09/2023)

REQUEST FOR SUBPOENA

 LB-0895 Rev. 04-11

REQUEST TO WITHDRAW APPEAL

 LB-0894 Rev. 04-11

DRUG FREE WORKPLACE PROGRAM APPLICATION

 LB-1111 (REV 10/21)

TENNESSEE WORKERS’ COMPENSATION INSURANCE POSTING NOTICE

 LB-0922 (REV. 4/18)

TENNESSEE WORKERS’ COMPENSATION INSURANCE POSTING NOTICE (Spanish)

 LB-0922SP (REV. 4/18)

OSHA's Form 300A Summary of Work-Related Injuries and Illnesses

 TOSHA 300 (Rev. 01/2004)

UTILIZATION REVIEW CLOSURE

 FORM C-36/C-37 / LB-0375 (REV. 05/23)

UTILIZATION REVIEW CLOSURE FORM INSTRUCTIONS

C-36/C-37 Instructions Undated Form

NOTICE OF APPEAL RIGHTS FOR A UTILIZATION REVIEW DENIAL

 FORM C-35A / LB-1023 (REV 03/22)

UTILIZATION REVIEW NOTIFICATION

 FORM C-35 / LB-0380 (REV. 05/23)

WAGE STATEMENT

 FORM C-41 / LB-0384 (REV 11/15)

NOTICE OF WITHDRAWAL OF A PREVIOUSLY SIGNED WAIVER

 LB-0290 / FORM I-13 (REV 11/15)

WORKERS’ COMPENSATION STATISTICAL DATA FORM

 FORM SD1 / LB-0904 (REV. 06-16)
Disclaimer: These forms may not be the most recent version. Tennessee may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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