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Labor and Economic Opportunity

Form FA 112 (8/19) - Application for Reimbursement

The Form 112 – Application for Reimbursement and supporting documentation may be submitted via upload through the File Transfer Service (FTS), a secure website portal.

Note: Form 112’s uploaded to the FTS are submitted to a different Mailbox than the Workers’ Disability Compensation Agency forms. If you already have a FTS account established, use Mailbox: WCFUNDSA and Application ID: 112FA when uploading the Form 112.

Those interested in participating that do not have a FTS User Account can email Diane Harger at hargerd@michigan.gov. An account will be established and the necessary instructions on how to upload the Form 112 via the FTS, including user ID, password, etc., will be provided.

Click for Form 112