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 33 State Forms found

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ACT Enrollment and Direct Deposit Authorization

 BWC-0019 A-12 (10/30/2023)

Amended True-Up Payroll Report

 BWC-7578 RPS-Amend P/R (Rev.May 29, 2024)

Application for Payment of Lump Sum Advancement

 BWC-1150 C-32 (Rev. Dec. 26, 2023)

Application for Retrospective-Rating Plan for Private Employers

 BWC-7523 U-20 (Rev. Feb. 22, 2024)

Application for Retrospective Rating Plan for Public Employers

 BWC-7523 U-21 (Rev. Feb. 23, 2024)

Authorization for Living Maintenance Wage Loss

 BWC-2968 RH-18 (Rev. Nov. 19, 2023)

Authorization to Receive Workers' Compensation Check

 BWC-1360 C-230 (Rev. Oct. 2, 2023)

Authorization to Receive Workers' Compensation Check (Spanish)

 BWC-1360 C-230-ES (Rev. 2 de octubre de 2023)

Completing the Injured Worker Statement for Reimbursement of Travel Expense

 BWC-1178 C-60 (Rev. Nov. 30, 2023)

Direct Deposit Automatic Comp Transfer Bank Change

 BWC-0045 A-35 (Rev. Dec. 21, 2023)

EBT - Electronic Benefit Card Enrollment Application

 A-21 Revised March 17, 2025

Employer Incentive Contract

 BWC-2970 RH-19 (Rev. Jan. 16, 2024)

Application for Wage Loss Compensation

 BWC-1267 C-140 (Rev. Sept. 22, 2023)

Labor Lease Transaction Payroll

 BWC-0519 AC-18 (Rev. March 28, 2024)

Lump Sum Settlement (LSS) Direct Reimbursement Rating and Payment Program for Public Employer State Agencies

 BWC-7651 U-145 (Rev. April 26, 2024)
Disclaimer: These forms may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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