Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with CorVel Corporation (on behalf of the Tennessee Department of Treasury, Criminal Injuries Compensation Program) before sending sensitive documents. FaxFlow is not affiliated with this organization.
CorVel Corporation (on behalf of the Tennessee Department of Treasury, Criminal Injuries Compensation Program) fax number
(866) 727-5569
Criminal Injuries Compensation Program
Used for: Employer's Statement for Lost Wages
Fax destination details
- Department
- Criminal Injuries Compensation Program
- Purpose
- Employer's Statement for Lost Wages
- Form
- TR-0300A (Rev. 1/05) RDA-1178 — Employer's Statement
- Address
- 2000 Mallory Lane, Franklin, TN 37067-8231
- Voice phone
- (866) 960-6039
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Employer completes Parts II–IV of the Employer's Statement and certifies the information; the form is sent to CorVel Corporation for processing under the Tennessee CIC Lost Wages claim.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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