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Texas Forms

52 State Forms found

name	number	revision	print or send online
REQUEST TO ADJUST AVERAGE WEEKLY WAGE FOR SEASONAL EMPLOYEE	DWC055	Rev. 02/17
REQUEST TO ADJUST AVERAGE WEEKLY WAGE FOR SEASONAL EMPLOYEE (Spanish)	DWC055S	Rev. 02/17
Request for a lump sum payment of impairment income benefits (IIBs) (Spanish)	DWC051S	Rev. 06/23
Request to get reimbursed for travel costs (Spanish)	DWC048S	Rev. 07/21
Notice of Employer Full Salary Payment - EDI	PLN-6	Rev. 07/21
Notice of Change of Indemnity Benefit Type - EDI	PLN-7	Rev. 11/24
Notice of Employer Full Salary Payment (Spanish) - EDI	PLN-6S	07/21
Notice of Change of Indemnity Benefit Type (Spanish) - EDI	PLN-7S	Rev. 11/24
Notice of Change in Amount of Indemnity Benefit Payment - EDI	PLN-8	Rev. 07/23
Notice of Change in Amount of Indemnity Benefit Payment (Spanish) - EDI	PLN-8S	Rev. 07/23
Notice of Suspension of Indemnity Benefits - EDI	PLN-9	Rev. 07/21
Notice of Suspension of Indemnity Benefits (Spanish) - EDI	PLN-9S	07/21
Notice of Disputed Issue(s) and Refusal to Pay Benefits (Spanish) - EDI	PLN-11S	Rev. 07/23
Subsequent Injury Fund Reimbursement Request Form - Overturned Order or Designated Doctor Opinion	DWC095	Rev. 01/2021
Notice of Reinstatement of Indemnity Benefits - EDI	PLN-10A	Rev. 07/23

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Disclaimer: These forms may not be the most recent version. Texas 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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