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This information is provided free of charge by the Department of Industrial Relations from its web site at www.dir.ca.gov. These regulations are for the convenience of the user and no representation or warranty is made that the information is current or accurate. See full disclaimer at https://www.dir.ca.gov/od_pub/disclaimer.html.
 
Chapter 8. Office of the Director
Subchapter 7. Return-to-Work Supplement
Article 1.

New query


§ 17306. Application Contents.


The application shall be made on the electronic form on the Department of Industrial Relations web site and shall include a declaration under penalty of perjury that the information provided is true and correct. The application shall contain the individual's first name, last name and middle name, social security number or tax ID number, address, telephone number and email address, if available, and the ADJ number of any workers' compensation cases filed by the individual, and the individual shall submit a .pdf or .tiff of the Voucher as an attachment to the application. The individual shall indicate whether the individual is a California resident or a non-resident.
Note: Authority cited: Sections 54, 55 and 139.48, Labor Code. Reference: Section 139.48, Labor Code.
HISTORY
1. New section filed 4-6-2015; operative 4-6-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 15).


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