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Get Ie Shaffer 351
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How to fill out the Ie Shaffer 351 online
The Ie Shaffer 351 form is essential for applying for temporary disability benefits. This guide will provide you with step-by-step instructions on how to complete the form online, ensuring a smooth and efficient submission process.
Follow the steps to successfully complete the Ie Shaffer 351 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part I, begin by entering your personal information. Fill in your full name, social security number, street address, city, state, and zip code. Don’t forget to add your telephone number and the date you were last employed, along with the name of your last employer.
- In Part II, this section needs to be completed by your physician. They should record the nature of your illness or injury, the date of your first treatment, and the date of the most recent treatment.
- Part III requires you to choose between two options regarding federal income tax withholding from your benefits. Select Option A if you do not wish to have taxes withheld, or Option B to specify an amount to be withheld.
- After completing the form, review all sections for accuracy. Make any necessary corrections.
Complete the Ie Shaffer 351 form online today to ensure you receive your temporary disability benefits promptly.
Active Payer List - Effective February 2021 SB580 CareFirst BCBS DC,Nat Capital Area Professional Institutional 95964 CARES ACT PROVIDER RELIEF FUND Professional Institutional 31114 CareSource Professional Institutional 68068 Cenpatico - Behavioral Professional Institutional 68069 Centene - Medical Professional Institutional20 more rows
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