Form 192002 with OSHA 301 info 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the Claimant section, including your name, Social Security number, address, and telephone number.
3. In the Felony Convictions Involved section, provide details about each felony conviction, including the date, county, and court file number.
4. Fill in the Dates of Incarceration and Places of Incarceration fields accurately to reflect your incarceration history.
5. Indicate whether you received a Pardon of Innocence or if charges were dismissed by a three-judge panel. Provide the relevant dates as required.
6. State your claim for compensation clearly in the designated area, specifying the amount and duration of incarceration.
7. Attach any necessary supporting documents such as certified copies of judgments or pardons as indicated on the form.
8. Finally, sign and date the petition before submitting it to the North Carolina Industrial Commission as instructed.

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