Application for Wage Loss Compensation Forms
| Form Name | Application for Wage Loss Compensation |
| Form # | BWC-1267 C-140 |
| Form Revision | (Rev. April 14, 2026) |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Ohio |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |