Free Microsoft Word - 57149_117548 - Oregon


File Size: 40.1 kB
Pages: 3
File Format: PDF
State: Oregon
Category: Workers Compensation
Author: SYSTEM
Word Count: 179 Words, 1,342 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.cbs.state.or.us/external/wcb/pdf_file/forms/postcardpac2.pdf

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Please find attached a camera-ready copy of the Workers' Compensation Board's Claims Disposition Agreement (CDA) postcard on 8-1/2" x 11" paper, showing the Board's prescribed format, as well as a completed postcard. The size of the postcard is 4" x 6" on 100 to 110 lb. card stock. You may use any color paper (except red because postmarks do not show up on red postcards), and you may add any internal information you need to the postcard as long as the Board's prescribed format and size are followed.

Before the Workers' Compensation Board of The State of Oregon In the Matter of the Compensation of ) ) ) ) ) ) CDA No: ______________________
(for office use only)

Claim No: ______________________ Announcement of CDA Approval Order

,
(Name)

, the Board or the Administrative Law Judge (ALJ) On who mediated the agreement approved the parties' claim disposition agreement (original/amended). Payments shall be made in accordance with the agreement. The Board's decision is final and is not subject to review. ORS 656.236(2). Workers' Compensation Board/ALJ by __________________________ CDA Unit/WCB Staff

To:

______________________________________
(Name)

______________________________________
(Mailing Address)

______________________________________
(Mailing Address)

______________________________________
(City, State, Zip)