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Printable Form 4876-A Vallejo California: What You Should Know

Complete, electronically print out, and return this form to us within 10 days of your application. Form 8606-M, Medical Leave from Employment for Certain Disability Compensation Eligibility to Claim Benefits Available through the Medical Leave from Employment (ME) Program is based on your  religion, sex, and marital status. Click Here for the Medical Leave from Employment for Certain Disability Compensation Information to Be Provided to the Department of Labor by This Beneficiary A beneficiary is an individual or corporation who receives an individual payment pursuant to the Department of Labor's (DOL) Regulations. The department will prepare and file a Form 8606 for the beneficiary(s) or for this program as applicable. When a beneficiary file Form 8606-M, they will include their own Social Security Number and their Medicare number. Please note in the comments section whether (a) you have received a payment for the same or a similar  claim and (b) if so, what payment amount was received. Additionally, a copy of your Form 8606 -M must be  entered with your original application for benefits. Information for This Beneficiary For information on the Medical Leave from Employment for Certain Disability Compensation, use the form below. If you need assistance completing this form, please click Here to access information from the program. Forms Employment Insurance Form 716, Workforce Investment Act Payment Statement for Employment Insurance (WIN) Beneficiaries of the Department of Labor Form 8606-M, Medical Leave from Employment for Certain Disability Compensation Applicant — Select the category for your claim from the drop-down menu or select the link below to return to the list of available information. If you do not wish to provide any information on Form 8606-M, please select the link below to return to the list of available information.

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