Disability 2004 form-2025

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4 out of 5

40 votes

The document is a notice and proof of claim form for disability benefits, outlining the process for claimants who become sick or disabled while employed or within four weeks after employment termination. It includes instructions for completing the claimant's statement and requires a health care provider's statement to be submitted. The form emphasizes accuracy in reporting information and provides legal warnings regarding fraud.

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See more disability 2004 form versions

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Versions	Form popularity	Fillable & printable
2022	4.9 Satisfied (60 Votes)
2020	4.9 Satisfied (43 Votes)
2019	4.4 Satisfied (143 Votes)
2017	4.1 Satisfied (22 Votes)
2004	4.4 Satisfied (384 Votes)
2004	4 Satisfied (40 Votes)

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Disability 2004 form-2025

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