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Kentucky Request for Manual Changes
SKU: FFKY280 |   E-mail this product to a friend
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Reminder: After you have selected your free form(s) and added it to your cart, you are to complete the checkout process. You will not be charged for the form(s). Upon completion of the checkout process, you will be sent an email with a link to download your free form(s). For more information click here.
 
 
Product Description

A Manual Change Form is required to change the Date of Injury; Nature of Injury; and Social Security Number due to the fact that these are locked fields in the DWC electronic database. Your signed form may be faxed or mailed. Changes will be made by the DWC staff once the signed form is received. The Manual Change Form must be followed by an 02 transaction containing the updated fields. For faxed forms, the 02 can be transmitted immediately. If mailed, please allow five days before submitting the 02 change. Forms not signed will be returned for signature, thus delaying the change requested.

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