Affidavit Of Significant Financial Hardship {AS01}

MN AS01 - AFFIDAVIT OF SIGNIFICANT FINANCIAL HARDSHIP. This form is used in Minnesota’s Workers’ Compensation Court of Administrative Hearings when an injured employee requests that their claim be considered on an expedited basis due to severe financial hardship. By completing this form, the employee provides a sworn statement detailing their income, debts, living expenses, dependents, and any additional household income or benefits. The form also requires the employee to describe urgent circumstances such as the threat of foreclosure, eviction, or repossession of essential property, as well as any other exceptional factors contributing to their financial distress. This affidavit supports a petition for a faster hearing under the Workers’ Compensation Act so that the employee’s dispute with their employer or insurer can be resolved more quickly. It must be signed in the presence of a notary public and attached to the employee’s claim petition. The information provided becomes part of the official workers’ compensation case file and helps the court determine whether expedited relief is warranted. www.FormsWorkflow.com