Form A-12 (BWC-0019) Act Enrollment and Direct Deposit Authorization - Ohio

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form A-12 (BWC-0019) for the current year.

Form A-12 (BWC-0019) Act Enrollment and Direct Deposit Authorization - Ohio

What Is Form A-12 (BWC-0019)?

This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 15, 2022;
  • The latest edition provided by the Ohio Bureau of Workers' Compensation;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form A-12 (BWC-0019) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.

ADVERTISEMENT

Download Form A-12 (BWC-0019) Act Enrollment and Direct Deposit Authorization - Ohio

4.8 of 5 (20 votes)
  • Form A-12 (BWC-0019) Act Enrollment and Direct Deposit Authorization - Ohio, Page 1
ADVERTISEMENT