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This version of the form is not currently in use and is provided for reference only. Download this version of
Form WCB-4A
for the current year.
Form WCB-4A Consent Between Employer and Employee - Maine
What Is Form WCB-4A?
This is a legal form that was released by the Maine Workers' Compensation Board - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form WCB-4A?
A: Form WCB-4A is a Consent Between Employer and Employee in Maine.
Q: What is the purpose of Form WCB-4A?
A: Form WCB-4A is used to obtain the employee's consent for workers' compensation purposes.
Q: Who needs to fill out Form WCB-4A?
A: Both the employer and the employee need to fill out Form WCB-4A.
Q: What information is required on Form WCB-4A?
A: Form WCB-4A requires information such as the employee's name, date of birth, and consent to the release of medical records.
Q: Is Form WCB-4A confidential?
A: Yes, the information obtained on Form WCB-4A is confidential and is used only for workers' compensation purposes.
Q: Can Form WCB-4A be used for any other purpose?
A: No, Form WCB-4A is specifically for workers' compensation purposes and cannot be used for any other purpose.
Q: Are there any filing fees for Form WCB-4A?
A: No, there are no filing fees for Form WCB-4A.
Form Details:
- Released on September 1, 2020;
- The latest edition provided by the Maine Workers' Compensation Board;
- 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 Form WCB-4A by clicking the link below or browse more documents and templates provided by the Maine Workers' Compensation Board.
