Fillable 801 form 2026

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The document is a workers' compensation claim form that outlines the process for reporting job-related injuries or illnesses. It includes sections for the worker to provide details about the injury, employer information, and instructions on filing a claim with SAIF Corporation. Additionally, it offers guidance on medical treatment, reimbursement for expenses, and the rights of injured workers regarding their claims.
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  1. Click ‘Get Form’ to open the fillable 801 form in the editor.
  2. Begin by entering the 'Date of injury or illness' in the designated field. This is crucial for your claim.
  3. Fill in the 'Date you left work' and 'Time of injury or illness', selecting a.m. or p.m. as appropriate.
  4. Indicate your 'Shift on day of injury' and check if you are employed by more than one employer.
  5. Provide details about your injury, including what caused it, and any witnesses present at the time.
  6. Complete personal information fields such as your legal name, birthdate, mailing address, and SSN.
  7. Review all entries for accuracy before signing at the bottom of the form to authorize your claim.

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Versions Form popularity Fillable & printable
2020 4.6 Satisfied (23 Votes)
2017 4.8 Satisfied (160 Votes)
2016 4.3 Satisfied (93 Votes)
2011 4.3 Satisfied (66 Votes)
2010 4 Satisfied (37 Votes)
2005 4 Satisfied (49 Votes)
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How do I submit my documents to the secretary of state for filing? Online: SOSDirect or SOSUpload (electronic filing of many, but not all, types of documents) Mail: Corporations Section. P. O. Box 13697. Austin, Texas 78711-3697. Delivery: James Earl Rudder Office Building. 1019 Brazos. Austin, Texas 78701.
Submit the completed form(s) in duplicate along with the filing fee. The form(s) may be: (1) mailed to P.O. Box 13697, Austin, Texas 78711-3697; (2) faxed to (512) 463-5709; or (3) delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701.
An entity forfeited under the Tax Code can reinstate at any time (so long as the entity would otherwise continue to exist) by (1) filing the required franchise tax report, (2) paying all franchise taxes, penalties, and interest, and (3) filing an application for reinstatement (Form 801 Word 178kb, PDF 87kb),
File by phone Call us toll free at 1.888. 373.8689. If youre calling from Salem, call us at 503.373. 8295.
Complete and submit Form 05-359, Request for Certificate of Account Status to Terminate a Taxable Entitys Existence in Texas or Registration (PDF), or request the certificate online using Webfile.

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Form 801 is used to report certain payments received by state and local government agencies that are used for agency purposes and paid by a third party which may include a payment for an officials travel expenses for the purpose of facilitating the publics business in lieu of using agency funds; and a payment that
Reinstatement / Revival for Limited Liability Companies: Agency:Texas Secretary of State - Corporations Section Form: Form 811: Reinstatement Filing Method: Mail or online. Agency Fee: $15 for reinstatement after voluntary termination and $75 for reinstatement after involuntary termination or revocation.1 more row
Fill out Form 801 Report of Job Injury or Illness and turn it in to your employer. Your employer should send it to its workers compensation insurance carrier within five days of your notice. Your employer should provide you this form.

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Report of Job Injury or Illness

To make a claim for a work-related injury or illness, fill out the worker portion of this form and give it to your employer. 801.

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Report of Job Injury or Illness, 801

To make a claim for a work-related injury or illness, fill out this form and give to your employer. If you do not intend to file a workers compensation

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