State Form 34401 Indiana Worker's Compensation First Report of Employee Injury, Illness - Indiana

What Is State Form 34401?

This is a legal form that was released by the Indiana Department of Workforce Development - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 34401?
A: Form 34401 is the Indiana Worker's Compensation First Report of Employee Injury, Illness form.

Q: What does Form 34401 document?
A: Form 34401 documents employee injury or illness for Worker's Compensation purposes in Indiana.

Q: Who should fill out Form 34401?
A: Employers should fill out Form 34401 when an employee experiences an injury or illness.

Q: What information is required on Form 34401?
A: Form 34401 requires detailed information about the employee, their injury/illness, and the incident itself.

Q: When should Form 34401 be submitted?
A: Form 34401 should be submitted within 10 days of the injury or illness occurrence.

Q: What are the consequences of not submitting Form 34401?
A: Failing to submit Form 34401 may result in penalties or delays in receiving Worker's Compensation benefits.

Q: Are there any fees associated with submitting Form 34401?
A: No, there are no fees associated with submitting Form 34401.

Q: What should I do if I have questions about Form 34401?
A: If you have questions about Form 34401, you can contact the Indiana Worker's Compensation Board for assistance.