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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 A-12 (BWC-0019)
for the current year.
Form A-12 (BWC-0019) Act Enrollment and Direct Deposit Authorization - Ohio
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What Is Form A-12 (BWC-0019)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
Form Details:
- Released on November 15, 2022;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form A-12 (BWC-0019) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
