Example: bankruptcy

Work Status Form (F242-052-000)

• A Work Status Form which you complete to request benefits.You must complete this form each tim e you receive it. Your work status: • We need to know if you missed time from : any: work due to your injury. • It’s important to notify L&I if you’re engaged in activity that includes, but isn’t limited to volunteer work,

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  Work, Status, Work status

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