H a n d S
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Organization Registration
Instructions Guide
Organization Information
Organization Type
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Workplace Safety Committee
Insurer
Self-Insurer
Are you a Commonwealth Agency?
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No
Yes
Agency ID
Are you a PA School District?
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No
Yes
School AUN
FEIN
Confirm FEIN
NAIC Code
Bureau Code
Organization Name
Address Line 1
Address Line 2
City
State
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Alabama
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Texas
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Virgin Islands
Virginia
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Wisconsin
Wyoming
ZIP
ZIP + 4
Electronic Notification
By indicating "yes" in the space below, I request and agree that:
1) All communications, notices or documents requested under, required by or otherwise provided pursuant to 34 Pa. Code Chapter 129 (relating to Health and Safety) will be provided to me electronically through the HandS system. 2) Communications, notices or documents that require my attention will be provided to me via the HandS system. I will not receive any other indication that these communications, notices or documents require my attention. These Communications, notices or documents will only be available through the HandS system. 3) I will accept electronic service, through HandS, of any document required, under 34 Pa. Code Chapter 129, to be served upon me in lieu of service of such document by mail or by any other means. 4) I will communicate and file any documents that I am required or wish to file under Article X of the Pennsylvania Workers’ Compensation Act and 34 Pa. Code Chapter 129 via the HandS system. 5) I will routinely log on to the HandS system to retrieve messages, documents or other correspondence that may require my attention, and will ensure that my user profile contains an accurate, active email address. I understand and agree that I am responsible for retrieving and responding to such messages in the same manner as if those messages were provided by mail. 6) My consent and agreement to receive communications electronically remains effective until I revoke such consent by indicating "No" in the space below. I may revoke my consent at any time, from which point forward all documents not already provided via HandS will be submitted and delivered in paper form.
Would you like to receive Electronic Dashboard Notices?
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No
Yes
User/Contact Information
Title
Prefix
First Name
*
Last Name
*
Primary Contact Person
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Miss
Rev.
Sister
Dr.
Mr.
Mrs.
Ms.
Phone Number
*
EXT
Email Address
*
Prefix
First Name
*
Last Name
*
Secondary Contact Person
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Miss
Rev.
Sister
Dr.
Mr.
Mrs.
Ms.
Secondary Email Address
*
User ID
*
Password
*
Confirm Password
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Please select a question and provide an answer. This information will be used in case you forget your password.
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What is your mother’s maiden name?
What is the name of your city of birth?
What is the name of your elementary school?
What is the name of your high school?
What is your father’s middle name?
What is your maternal grandmother’s maiden name?
What is your paternal grandmother’s maiden name?
What is your pet’s name?
What is your favorite color?
What is your favorite food?
Who is your favorite person?
What is your favorite book?
Security Answer
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Status
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Active
Inactive
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