Indiana Work Request Cover Sheet

State:
Multi-State
Control #:
US-212-AZ
Format:
PDF; 
Rich Text
Instant download

Description

A cover sheet is an informational form required to be filed in certain cases. The coversheet contains names and addresses of parties, the case type, and other organizational information. The court uses this information for statistical purposes and to organize the case for hearing. This form, a Work Request Cover Sheet for the type of case indicated (or a general cover sheet) is available for download now in standard format(s). USLF control no. US-212-AZ

How to fill out Work Request Cover Sheet?

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FAQ

Please continue to use the contact information provided on the action you are disputing, or contact OALP by emailing fssa.appeals@oalp.in.gov or calling 317-234-3488 or 1-866-259-3573.

Fax: 800-403-0864 or deliver or mail to your local county office. FSSA: DFR: Forms - IN.gov in.gov ? dfr ? forms-documents-and-tools in.gov ? dfr ? forms-documents-and-tools

Enter your user ID and password. in, navigate to the Application Summary for Online Application(s) section or Cases section and find the application or case number you want to upload to. Use the ?Upload Documents? button to begin the upload. Documents? button, you will be taken to the Document Upload screen.

Establishing an Authorized Representative with the state The form needs to be signed by you and the person you authorize as your representative. It should then be filed with the state by fax to 800-403-0864 or delivered by mail or in person to your local county office. Authorized Representative/Disclosure forms - FSSA: HIP - IN.gov in.gov ? fssa ? hip ? for-hip-members ? aut... in.gov ? fssa ? hip ? for-hip-members ? aut...

A Legally authorized representative (LAR) is an individual or judicial or other body authorized under applicable law to make decisions on behalf of another individual.

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Indiana Work Request Cover Sheet