Section 304.2 Application For Religious Exception Of Specified Employes {LIBC-14A}

LIBC-14A - SECTION 304.2 APPLICATION FOR RELIGIOUS EXCEPTION OF SPECIFIED EMPLOYEES FROM THE PROVISIONS OF THE PENNSYLVANIA WORKERS’ COMPENSATION ACT. This form, titled "Section 304.2 Application for Religious Exception of Specified Employees from the Provisions of the Pennsylvania Workers’ Compensation Act," is used in Pennsylvania by employers seeking an exception from providing workers' compensation benefits to employees who are members of a religious sect with objections to such benefits. The form requires employers to provide information about their business, the total number of employees seeking exception, and details of each employee requesting the exception. For each employee, the employer must list their personal information and affiliation with a religious sect, along with the name and contact details of the religious sect leader. The employer or an authorized officer must sign the application, certifying the accuracy of the information provided. The form also includes a notice warning against providing misleading or incomplete information, as it could lead to legal penalties. If not filed electronically, the original form must be sent to the Bureau of Workers’ Compensation Compliance Section in Harrisburg, PA. www.FormsWorkflow.com