Application for Employer Reporting Internet Access
BA-12 (07-17).pdf
RUIA Claims Notification and Verification System
Application for Employer Reporting Internet Access
OMB: 3220-0171
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0171 can be found here:
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| File Type | application/pdf |
| File Title | KM_284e-20171222112158 |
| File Modified | 2017-12-22 |
| File Created | 2017-12-22 |