104a form 2025

Show details

4.3 out of 5

353 votes

The document is an application form (OCR 104A) for mediation or hearing related to workers' compensation claims in Michigan. It is specifically designed for employees to report injuries, request benefits, and provide necessary personal and employment information. The form requires details about the employee, employer, nature of the injury, dates of employment, and any other benefits received. It also includes sections for medical providers and witnesses. The application must be completed accurately and submitted to the Workers’ Compensation Agency.

Here's how it works

01. Edit your 104a form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send form 104a via email, link, or fax. You can also download it, export it or print it out.

The easiest way to edit 104a form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Adjusting paperwork with our extensive and intuitive PDF editor is easy. Follow the instructions below to fill out 104a form online quickly and easily:

Log in to your account. Log in with your credentials or register a free account to try the product prior to upgrading the subscription.
Upload a form. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit 104a form. Quickly add and underline text, insert images, checkmarks, and signs, drop new fillable areas, and rearrange or remove pages from your document.
Get the 104a form accomplished. Download your modified document, export it to the cloud, print it from the editor, or share it with other participants via a Shareable link or as an email attachment.

Benefit from DocHub, the most straightforward editor to quickly manage your documentation online!

See more 104a form versions

We've got more versions of the 104a form form. Select the right 104a form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (113 Votes)
2019	4.3 Satisfied (56 Votes)
2013	4.3 Satisfied (353 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What happens if a spouse refuses to be served divorce papers?

In California, its a legal requirement to ensure your spouse is formally notified of the divorce and given a chance to respond. Serving divorce papers guarantees fairness in the legal process. If your spouse refuses to cooperate, it might delay the timeline, but it wont stop the divorce entirely.

What is a FL 110 form?

Tells your spouse or domestic partner that a court case has started, your rights and responsibilities, and what can happen if a response is not filed in 30 days. Get form FL-110.

What is the purpose of the MV 104 form?

The MV-104 form records important details about accidents, including the parties and vehicles involved, and the events leading up to the crash. Accurately and promptly completing the form assists insurance claims, aids law enforcement, and ultimately contributes to road safety.

What is an FL 110?

Petition and Summons (FL-100 and FL-110) If you received these forms, your spouse or domestic partner is asking the court to legally change your marriage or domestic partnership. Usually, this means theyre asking for a divorce. They may be asking for a legal separation or annulment.

What is proof of service 104?

Proof of Service (Small Claims) (SC-104) Tell the court you had the other side served with the papers you filed to start the Small Claims case. The person who delivered the papers (your server) must sign the form.

What is an SC 100A form?

Other Plaintiffs or Defendants (SC-100A) Use this form if you are filing a case that involves three or more Plaintiffs or Defendants. Fill out this form and attach it to your Plaintiffs Claim. Download Other Plaintiffs Form. Proof of Service (SC-104)

104a form 2025

Here's how it works