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Name
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File Type
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Programs
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Most Viewed
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Alliance Employee Acknowledgement of Requirements
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PDF
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Workers' Compensation
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Alliance Employee Acknowledgement of Requirements in Spanish
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PDF
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Workers' Compensation
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Alliance Treating Doctor Change Request
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PDF
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Workers' Compensation
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Application for Fund Coverage
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PDF
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General
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Bona Fide Offer of Employment
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DOC
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Workers' Compensation
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Bona Fide Offer of Employment (Spanish)
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DOC
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Workers' Compensation
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DWC 1, Employer's First Report of Injury (FROI) (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 156, Prospective Employment Authorization and Certification Form (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 2, Employer's Report for Reimbursement of Voluntary Payment (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3, Employer's Wage Statement (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3, Employer's Wage Statement (App)
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HTML
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Workers' Compensation
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DWC 32, Request for Designated Doctor Examination (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3ME, Employee's Multiple Employment Wage Statement (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3MES, Declaracíon de Salario de Múltiples Trabajos de Empleado (tdi.texas.gov) (Spanish)
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PDF
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Workers' Compensation
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DWC 3SD, Employer's Wage Statement for School Districts (App)
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HTML
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Workers' Compensation
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DWC 3SD, Employer's Wage Statement for School Districts (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3SDS, Declaracíon de Salario Para Escuelas de Distrito (tdi.texas.gov)(Spanish)
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PDF
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Workers' Compensation
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|
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DWC 4, Employer's Contest of Compensability (tdi.texas.gov)
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PDF
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Workers' Compensation
|
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DWC 41, Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 45, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC) (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 47, Employee's Request for Advance of Benefits (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 48, Request for Travel Reimbursement (tdi.texas.gov)(English and Spanish)
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PDF
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Workers' Compensation
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DWC 52, Application for Supplemental Income Benefits (tdi.texas.gov)
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PDF
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Workers' Compensation
|
|
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DWC 6, Supplemental Report of Injury (App)
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HTML
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Workers' Compensation
|
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DWC 6, Supplemental Report of Injury (tdi.texas.gov)
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PDF
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Workers' Compensation
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|
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DWC 68, Designated Doctor Examination Data Report (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 69, Report of Medical Evaluation
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PDF
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Workers' Compensation
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DWC 73, Work Status Report (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 74, Description of Injured Employee's Employment (tdi.texas.gov)
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PDF
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Workers' Compensation
|
|
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Electronic Fund Transfer Form
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PDF
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General
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Electronic Fund Transfer Form Unemployment Compensation
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PDF
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Unemployment
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|
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First Report of Injury (FROI)
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HTML
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Workers' Compensation
|
|
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GASB Statement 10
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HTML
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General
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Hartford Boiler Inspection Form
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PDF
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Property
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|
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Individual Wage Adjustment Form, C-7 (twc.state.tx.us)
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PDF
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Unemployment
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Leave Election Non-Offset Form
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DOC
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Workers' Compensation
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|
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Leave Election Non-Offset Form in Spanish
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DOC
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Workers' Compensation
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|
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Leave Election Offset Form
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DOC
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Workers' Compensation
|
|
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Leave Election Offset Form in Spanish
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DOC
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Workers' Compensation
|
|
|
Preauthorization Request for Healthcare Services
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PDF
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Workers' Compensation
|
|
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Preauthorization Request for Prescription Drugs
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PDF
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Workers' Compensation
|
|
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Program Coordinator Change Form
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PDF
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General
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|
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Total Wages Adjustment Form, C-5 (twc.state.tx.us)
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PDF
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Unemployment
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|
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Verification of Employment for a Reported Injury or Illness
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DOC
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Workers' Compensation
|
|
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WC002 Employers Report for Reimbursement of Voluntary Payment
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PDF
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Workers' Compensation
|
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