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State Form 47400 Report of Injury / Complaint of Injury - Indiana
What Is State Form 47400?
This is a legal form that was released by the Indiana Professional Licensing Agency - 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 47400?
A: Form 47400 is the Report of Injury/Complaint of Injury in Indiana.
Q: Who needs to fill out Form 47400?
A: Anyone who has been injured or wishes to file a complaint of injury in Indiana needs to fill out Form 47400.
Q: When should I submit Form 47400?
A: Form 47400 should be submitted as soon as possible after the injury or complaint of injury occurs.
Q: What information do I need to provide on Form 47400?
A: You will need to provide information about the injury, your personal details, and the circumstances surrounding the injury or complaint.
Q: Are there any filing fees associated with Form 47400?
A: No, there are no filing fees associated with Form 47400.
Q: What is the purpose of Form 47400?
A: Form 47400 is used to report and document workplace injuries or complaints of injury in Indiana.
Q: What happens after I submit Form 47400?
A: After you submit Form 47400, the Workers' Compensation Board will review the information and may initiate an investigation or take further action.
Q: What if I need assistance filling out Form 47400?
A: If you need assistance filling out Form 47400, you can contact the Indiana Workers' Compensation Board for guidance.
Form Details:
- Released on April 1, 2014;
- The latest edition provided by the Indiana Professional Licensing Agency;
- 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 State Form 47400 by clicking the link below or browse more documents and templates provided by the Indiana Professional Licensing Agency.
