Form FA 112 - 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 email@example.com. 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|