Statutes, codes, and regulations
California Code Of Regulations
Title 8 - Industrial RelationsDivision 1 - Department of Industrial RelationsChapter 8 - Office of the DirectorSubchapter 2.05 - Enforcement of Workers' Compensation Coverage, Penalty Assessment Orders, Stop Orders and Posting and Notice Requirements
Article 6 - Contents of Orders, of Direction to File Verified Statement and of Verified Statement
Section 15577 - Verified Statement

Cal. Code Regs. tit. 8 § 15577

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Current through Register 2024 Notice Reg. No. 25, June 21, 2024
Section 15577 - Verified Statement

The verified statement, which shall be mailed to the employer by the Workers' Compensation Appeals Board simultaneously with the issuance of Findings of Fact, Findings and Order or Findings and Award, shall be found on the reverse side of the Direction to File Verified Statement and shall contain the following information:

(a) That the employer must complete the verified statement and submit the requested information to the Division.
(b) The number of employees in the employer's employ on the date of injury.
(c) A certification under penalty of perjury by the employer that such number is true and correct.
(d) The employer's signature, address and the date and place of execution thereof.

Cal. Code Regs. Tit. 8, § 15577