California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 8 - Office of the Director
Subchapter 7 - Return-to-Work Supplement
Article 1
Section 17306 - Application Contents

Universal Citation: 17306 CA Code of Regs 17306
Current through Register 2024 Notice Reg. No. 38, September 20, 2024

The application shall be made on the electronic form on the Department of Industrial Relations web site and shall include a declaration under penalty of perjury that the information provided is true and correct. The application shall contain the individual's first name, last name and middle name, social security number or tax ID number, address, telephone number and email address, if available, and the ADJ number of any workers' compensation cases filed by the individual, and the individual shall submit a .pdf or .tiff of the Voucher as an attachment to the application. The individual shall indicate whether the individual is a California resident or a non-resident.

1. New section filed 4-6-2015; operative 4-6-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 15).

Note: Authority cited: Sections 54, 55 and 139.48, Labor Code. Reference: Section 139.48, Labor Code.

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