Settlement Agreements

Settlement Agreements

Agency*

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First Name*

Last Name

PERNR*

Retro Action*

Does any of the actions on the Action List document have effective dates greater than 60 days?

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Supporting Documentation*

Please attach all required documentation for OSHR Approval: * Settlement/Mediation Agreement *Action List

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Submitted By*

Submitted by Phone*

Submitted by email*

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