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This version of the form is not currently in use and is provided for reference only. Download this version of
Form F242-420-000
for the current year.
Form F242-420-000 Declaration of Entitlement for Surviving Spouse or Registered Domestic Partners Benefits Under Industrial Insurance - Washington
What Is Form F242-420-000?
This is a legal form that was released by the Washington State Department of Labor and Industries - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F242-420-000?A: Form F242-420-000 is a declaration of entitlement for surviving spouse or registered domestic partners benefits under industrial insurance in Washington state.
Q: Who is eligible to use this form?A: This form is for surviving spouses or registered domestic partners of workers who have passed away due to work-related injuries or illnesses in Washington.
Q: What benefits does this form provide?A: This form provides benefits to surviving spouses or registered domestic partners, including financial support and medical treatment related to the work-related injury or illness.
Q: Are there any deadlines for submitting this form?A: Yes, there are deadlines for submitting this form. It is important to submit the form as soon as possible after the worker's death to ensure timely processing of benefits.
Form Details:
- Released on April 1, 2017;
- The latest edition provided by the Washington State Department of Labor and Industries;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form F242-420-000 by clicking the link below or browse more documents and templates provided by the Washington State Department of Labor and Industries.
