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 62 State Forms found

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ADVANCEMENT OR LUMP SUM REQUEST

 WKC-136-E (R. 09/2024)

New Insurance or Insurance Change

 WKC-18151-E (R. 08/2023)

WAGE INFORMATION SUPPLEMENT for injuries occurring before April 10, 2022

 WKC-13-A (R. 09/2024)

EMPLOYER’S FIRST REPORT OF INJURY OR DISEASE (Spanish)

 WKC-12-S (R. 09/2024)

STATEMENT OF SELF-RESTRICTION TO PART-TIME WORK (Spanish)

 WKC-12698-E-S (R. 09/2024)

Complaint Form

 #102DLSC (Rev. 10/18)

Confidential Information Release Authorization

 DVR-199-E (R. 11-2019)

Confidential Information Release Authorization (Hmong)

 DVR-199-E-H (R. 05/2024) (T. 11/2019)

Confidential Information Release Authorization (Spanish)

 DVR-199-E-S (R. 05/2024) (T. 11/2019)

DISCONTINUED BY THE STATE, REPLACED WITH ID 9534 - Confidential Information Release Authorization

DVR-199-1-E - DEACTIVATED (N. 11/2019)

DISCONTINUED BY THE STATE, REPLACED WITH ID 9535 - Confidential Information Release Authorization (Hmong)

 DVR-199-1-E-H - DEACTIVATED (R. 11/2019)

DISCONTINUED BY THE STATE, REPLACED WITH ID 9536 - Confidential Information Release Authorization (Spanish)

 DVR-199-1-E-S - DEACTIVATED (N. 11/2019)

Mileage Reimbursement Record

 WKC-18613-E (R. 09/2024)

ADVANCEMENT OR LUMP SUM REQUEST (Spanish)

 WKC-136-E-S (R. 09/2024)

PRACTITIONER’S REPORT ON ACCIDENT OR INDUSTRIAL DISEASE IN LIEU OF TESTIMONY (Spanish)

 WKC-16-B-E-S (R. 09/2024)
Disclaimer: These forms may not be the most recent version. Wisconsin 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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