Form 170 Affidavit of Employee in Application for Trust Fund Benefits - Massachusetts

What Is Form 170?

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

FAQ

Q: What is Form 170?
A: Form 170 is an Affidavit of Employee in Application for Trust Fund Benefits in Massachusetts.

Q: Who needs to fill out Form 170?
A: Form 170 needs to be filled out by employees who are applying for trust fund benefits in Massachusetts.

Q: What are trust fund benefits in Massachusetts?
A: Trust fund benefits in Massachusetts are financial benefits provided to workers who have suffered work-related injuries or illnesses.

Q: What information is required on Form 170?
A: Form 170 requires information such as the employee's name, address, social security number, employer information, nature of injury or illness, and medical treatment details.

Q: Is there a deadline for submitting Form 170?
A: Yes, employees must submit Form 170 within four years of the date of injury or illness.

Q: Are there any fees associated with Form 170?
A: No, there are no fees associated with Form 170.

Q: What happens after submitting Form 170?
A: After submitting Form 170, the employee's claim will be reviewed, and if approved, the employee may be eligible to receive trust fund benefits.

Q: Who should I contact for more information about Form 170?
A: For more information about Form 170, you can contact the Massachusetts Department of Industrial Accidents.