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This Request for Temporary Total Compensation C 84 is the Application You Complete to Request Temporary Total 2019-2023

This Request for Temporary Total Compensation C 84 is the Application You Complete to Request Temporary Total 2019-2023

Use a c84 form 2019 template to make your document workflow more streamlined.

Provisions be punished by a fine imprisonment or both. Vocational rehabilitation information BWC will use this information to help facilitate your return to work. Signing the form means you have answered the questions truthfully and completely. It also means you are aware that you are not knowingly making a false statement misrepresentation concealment of fact or any other act of fraud to obtain compensation as provided by BWC or knowingly accepting compensation to which you are not entitled....
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*2012 OH C-84 [2012-06-26] 2019
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*2012 OH C-84 [2012-06-26] 2012
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