Application For Representative Identification Number (RIN) {BWC-6104} | Pdf Fpdf Doc Docx | Ohio

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Application For Representative Identification Number (RIN) {BWC-6104} | Pdf Fpdf Doc Docx | Ohio

Last updated: 11/21/2024

Application For Representative Identification Number (RIN) {BWC-6104}

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Description

BWC-6104 - APPLICATION FOR REPRESENTATIVE IDENTIFICATION NUMBER (R-4). This form is used by individuals or entities (such as attorneys, union representatives, or firms) to request a unique Representative Identification Number (RIN) from the Ohio Bureau of Workers' Compensation (BWC). This number allows the applicant to be designated as a representative for a specific workers' compensation claim, either for the employer or the injured worker. The form includes three options for application: one for individual attorneys, one for non-attorney representatives (such as union reps), and one for companies or organizations (such as law firms or third-party administrators). The application requires submission of taxpayer identification numbers, relevant certifications (e.g., attorney registration), and contact details. www.FormsWorkflow.com

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