Lien Filing Fee Refund Request {Form A}

FORM A - CA DIR LIEN FILING FEE REFUND REQUEST. This is a California Department of Industrial Relations (DIR) form used by lien filers to request a refund of a previously submitted lien filing fee. The form requires the payer’s identifying and contact information, lien reservation and claimant details, injured worker information, payment confirmation data, and the refund amount sought. It also provides structured checkboxes for selecting the basis of the refund—such as court-ordered refunds, incorrect lien fee payments, duplicate payments, exempt lien types, or system errors. Users must provide a detailed explanation and attach supporting documents like judge orders or receipts. The form must be completed, saved, and emailed to the DIR’s Lien and Reconciliation Unit, although submission does not guarantee approval. www.FormsWorkflow.com