Form Wc 14A PDF Details

When you're starting a new business, one of the first things you'll need is an Employer Identification Number (EIN). An EIN is like a Social Security number for your business - it's used to track your company's income and taxes. You can apply for an EIN online through the IRS website. The process is simple, and it only takes a few minutes. In this article, we'll walk you through the steps to apply for an EIN online. Let's get started!

QuestionAnswer
Form NameForm Wc 14A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameswc014a wc 14 form

Form Preview Example

WC-14a REQUEST TO CHANGE INFORMATION ON A PREVIOUSLY FILED FORM WC-14

GEORGIA STATE BOARD OF WORKERS' COMPENSATION

REQUEST TO CHANGE EMPLOYEE/CLAIMANT INFORMATION ON A PREVIOUSLY FILED FORM WC-14

Instructions: The purpose of this form is to change mistakes concerning certain information (Employee Name, SSN or Board Tracking #, Date of Injury, or County of Injury only) on a previously filed Form WC-14. This form shall not be used to change an address of record, add additional parties, or additional dates of injury.

Board Claim No.

Employee Last Name

Employee First Name

M.I.

SSN or Board Tracking #

Date of Injury

A. CHANGED INFORMATION

The information provided on the Form WC-14 dated

 

 

is amended as follows:

 

 

 

 

 

Change From

 

Change To

 

Employee Name

 

 

 

SSN or Board Tracking #

Date of Injury

County of Injury

Reasons for change(s) above:

B. CERTIFICATION

I certify that I have today sent a copy of this form to all parties in this claim and to the State Board of Workers’ Compensation, 270 Peachtree Street, NW, Atlanta, Georgia 30303-1299

Print name here

Address

Signature

City

State

Zip Code

E-mail

GA Bar number

Phone Number

Date

IF YOU HAVE QUESTIONS PLEASE CONTACT THE STATE BOARD OF WORKERS’ COMPENSATION AT 404-656-3818 OR 1-800-533-0682 OR VISIT http://www.sbwc.georgia.gov

WILLFULLY MAKING A FALSE STATEMENT FOR THE PURPOSE OF OBTAINING OR DENYING BENEFITS IS A CRIME SUBJECT TO PENALTIES OF UP TO $10,000.00 PER VIOLATION (O.C.G.A. §34-9-18 AND §34-9-19).

WC-14a

REVISION . 07/2011

14a

REQUEST TO CHANGE INFORMATION

ON A PREVIOUSLY FILED FORM WC-14