Authorization Number : 855-0759
Agency Series No. : PUB-01
Status : Active
Agency Web Link :
Agency : BWC
Confidential Description : The record contains the customer name, customer identification number, address, policy number, provider number, claim number, federal tax identification number, social security number, email address, item description and item name.
Division : BWCFDAD
Vital Description :
Section : BWCFDAD
Record Title : Requests for Forms
Revision : 2
Record Description : The Requests for Forms are from internal/external customers requesting publications or forms that are received via phone, fax, e-mail, US Mail, Internet or walk-in.