WORKERS' COMPENSATION BOARD REQUEST FOR …
REQUEST FOR FURTHER ACTION BY CARRIER/EMPLOYER. This form is submitted by carrier. self-insurer. ALL COMMUNICATIONS SHOULD REFER TO THESE NUMBERS. SEE IMPORTANT INFORMATION ON REVERSE - VEA INFORMACION IMPORTANTE AL DORSO. 10. Continuing payments directed by the Board should be suspended as of pursuant to 12 NYCRR 300.23(b).
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