California Audit Form PDF Details

The California State Auditor's website provides a Form which businesses can use to request an audit. The form is titled, "Request for Audit of Business," and it can be found on the website's main page under the heading "Forms and Publications." The Form is a pdf file and can be downloaded and printed. The Request for Audit of Business form is used to request an audit of a business entity or organization. The form can be filled out by individuals or by representatives of businesses or organizations. Completed forms should be sent to: California State Auditor, Attn: Request for Audit of Business, P.O. Box 101080, Sacramento, CA 95810-1080. The Request for Audit of Business form is a helpful resource for

QuestionAnswer
Form NameCalifornia Audit Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesca 906 form, audit referral, california audit form, au906

Form Preview Example

AUDIT COMPLAINT FORM

IF YOU WANT THIS COMPLAINT TO BE KEPT CONFIDENTIAL, PLEASE MARK THIS BOX:

DIR PRIVACY NOTICE: The Department of Industrial Relations, Division of Workers’ Compensation uses the information in your complaint (1) to monitor workers’ compensation claims administrators; (2) to assist DWC and other government agencies in general civil and criminal law enforcement; and (3) to conduct research on the workers’ compensation system. If you indicate that you want your complaint kept confidential, the Audit Unit will not share your complaint with any party named in your complaint. If you do not request confidentiality, the Audit Unit may share your complaint with the claims administrator. Please note that your complaint and your workers’ compensation claim information cannot be disclosed to the public under the Public Records Act. If you have questions about this notice please write to Privacy@dir.ca.gov.

Claims administrator / Company name

Claims administrator’s address

Injured worker name

Claim number

City, state, zip (physical location only- do not use P.O. Box) Date of injury

Date or period of violations

Employer

SPECIFIC DETAILS OF COMPLAINT

Describe the nature of the complaint, being as specific as possible. For example, late payments of temporary or permanent disability (the number of late payments, if known), failure to pay temporary or permanent disability, or 10% self- imposed penalties for late payments (indicate the periods not paid, if known), failure to pay or object to medical treatment or medical-legal bills, failure to investigate a claim, unsupported denial of liability for a claim, et al. Please attach copies of supporting documentation, if available.

Complainant (name & title)

Date

Address, city, state, zip code

Email: ______________________

 

DWC-AU-906 (Rev. 05/21)

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Step # 1 in submitting dwc audit form

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