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DWC Form 9767.17.5 (B) Part B DWC Petition for Suspension or Revocation of a Medical Provider Network - California
What Is DWC Form 9767.17.5 (B) Part B?
This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DWC Form 9767.17.5 (B)?
A: DWC Form 9767.17.5 (B) is the Petition for Suspension or Revocation of a Medical Provider Network in California.
Q: What is the purpose of DWC Form 9767.17.5 (B)?
A: The purpose of DWC Form 9767.17.5 (B) is to file a petition to suspend or revoke a Medical Provider Network in California.
Q: Who can use DWC Form 9767.17.5 (B)?
A: This form can be used by individuals or entities who want to petition for the suspension or revocation of a Medical Provider Network in California.
Q: What information is required in DWC Form 9767.17.5 (B)?
A: DWC Form 9767.17.5 (B) requires information such as the petitioner's contact details, reasons for the petition, and supporting documentation.
Q: What should I do once I complete DWC Form 9767.17.5 (B)?
A: Once you complete DWC Form 9767.17.5 (B), you should submit it to the appropriate address as specified on the form.
Q: Is there a fee for filing DWC Form 9767.17.5 (B)?
A: As of now, there is no fee mentioned for filing DWC Form 9767.17.5 (B). However, it is recommended to check the latest fee requirements with the DWC.
Q: How long does it take to process DWC Form 9767.17.5 (B)?
A: The processing time for DWC Form 9767.17.5 (B) may vary. It is recommended to contact the DWC for the most accurate information.
Form Details:
- Released on August 1, 2014;
- The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of DWC Form 9767.17.5 (B) Part B by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.
