Form FA 112 (1/14) - Application for Reimbursement
The Form 112 – Application for Reimbursement and supporting documentation may be submitted via upload through the Michigan Data Exchange Gateway (DEG), a secure website.
Note: Form 112’s uploaded to the DEG are submitted to a different Mailbox than the Workers’ Compensation Agency forms. If you already have a DEG account established use Mailbox: WCFUNDSA and Application ID: 112FA when uploading the Form 112.
Those interested in participating that do not have a DEG User Account can email Diane Harger at firstname.lastname@example.org. An account will be established and the necessary instructions on how to upload the Form 112 via the Michigan Data Exchange Gateway, including user ID, password, etc., will be provided.
|Click for Form 112|