Information required to be furnished by the employee.
When applying for sickness benefits, an employee shall report the name and address of the person or company, if any, who is alleged to have caused his or her infirmity. The employee shall also provide whatever other details are reasonably needed so that the Board may establish its lien.
The employee shall, upon request, tell the Board whether and from whom he or she has collected any damages for the infirmity.
(Approved by the Office of Management and Budget under control number 3220-0036)
[49 FR 570, Jan. 5, 1984, as amended at 52 FR 11018, Apr. 6, 1987]