Cal. Code Regs. tit. 8 § 17306

Current through Register 2024 Notice Reg. No. 24, June 14, 2024

Section 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.

Cal. Code Regs. Tit. 8, § 17306

1. New section filed 4-6-2015; operative 4-6-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 15).

Note: Authority cited: Sections 54, 55 and 139.48, Labor Code. Reference: Section 139.48, Labor Code.

1. New section filed 4-6-2015; operative 4/6/2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 15).