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