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Unemployment Insurance
Workers' Compensation
 
Product Manufacturer SKU More Info
Nevada A Supplemental Registration Form (NUCS-4058) StateFP FFNV130
Nevada Affidavit Concerning Deceased or Incompetent Person (NUCS-4172) StateFP FFNV035
Nevada Affidavit of Identity (NUCS-4128ID) StateFP FFNV025
Nevada Affirmation of Compliance with Mandatory Industrial Insurance Requirements (D-25) StateFP FFNV300
Nevada Alternative Choice of Physician or Chiropractor and Referral to a Specialist (D-52) StateFP FFNV415
Nevada An Employee's Guide to Nevada Workers' Compensation Insurance StateFP FFNV460
Nevada An Employer's Guide to Nevada Workers' Compensation Insurance StateFP FFNV455
Nevada Application for Reimbursement of Claim-Related Travel Expenses (D-26) StateFP FFNV305
Nevada Assignment of Claim for Workers' Compensation - Uninsured Employer (D-18) StateFP FFNV275
Nevada Authorization Request for Additional Chiropractic Treatment (D-32) StateFP FFNV335
Nevada Authorization Request for Additional Physical Therapy Treatment (D-33) StateFP FFNV340
Nevada Business Registration Form and Instructions (APP-01.00) StateFP FFNV125
Nevada Business Registration Form Instructions for UI Registration (NUCS-0736A) StateFP FFNV135
Nevada Claimant's Affidavit of Federal Civilian Services, Wages and Reason for Separation (ES-935) StateFP FFNV005
Nevada CMS 1500 Billing Form (D-34) StateFP FFNV345
Nevada Election for Nevada Workers' Compensation Coverage for Out-of-State Injury (D-15) StateFP FFNV260
Nevada Election of Coverage by Employer; Employer Withdrawal of Election of Coverage (D-44) StateFP FFNV385
Nevada Election of Method of Payment of Compensation (D-10a) StateFP FFNV225
Nevada Election of Method of Payment of Compensation for Disability Greater than 25 Percent (D-10b) StateFP FFNV230
Nevada Electronic Payment System Authorization Form (NUCS-4050EPS) StateFP FFNV090
Nevada Electronic Payment System Instructions (NUCS-4051EPS) StateFP FFNV095
Nevada Electronic Payment System Worksheet for filing Nevada's Employer's Quarterly Contribution and StateFP FFNV100
Nevada Employee's Claim for Compensation - Uninsured Employer (D-17) StateFP FFNV270
Nevada Employee's Claim for Compensation/Report of Initial Treatment (C-4) StateFP FFNV190
Nevada Employee's Declaration of Election to Report Tips (D-23) StateFP FFNV290
Nevada Employee's Election to Reject Coverage and Election to Waive the Rejection of Coverage D-43 StateFP FFNV380
Nevada Employer's Quarterly Contribution and Wage Report and Instructions (NUCS-4072) StateFP FFNV105
Nevada Employer's Quarterly List of Wages Paid - Continuation Sheet (NUCS-4073) StateFP FFNV110
Nevada Employer's Report of Changes (NUCS-4074) StateFP FFNV115
Nevada Employer's Report of Industrial Injury or Occupational Disease (C-3) StateFP FFNV185
Nevada Employer's Wage Verification Form (D-8) StateFP FFNV210
Nevada Explanation of Wage Calculation. (D-7) StateFP FFNV205
Nevada Fatality Report (D-21) StateFP FFNV280
Nevada Firemen and Police Officers' Extensive Heart Examination Form (OD-3) StateFP FFNV430
Nevada Firemen and Police Officers' Hearing Examination Form (OD-5) StateFP FFNV440
Nevada Firemen and Police Officers' Limited Heart Examination Form (OD-4) StateFP FFNV435
Nevada Firemen and Police Officers' Lung Examination Form (OD-2) StateFP FFNV425
Nevada Firemen and Police Officers' Medical History Form. (OD-1) StateFP FFNV420
Nevada Firemen and Police Officers' Sample Letter (OD-6) StateFP FFNV445
Nevada Information For the Unemployed Worker (NUCS-4139) StateFP FFNV030
Nevada Information Page (D-49) StateFP FFNV405
Nevada Information Regarding Physical Examinations for Firemen and Police Officers (OD-7) StateFP FFNV450
Nevada Informational Poster - Displayed by Employer (D-1) StateFP FFNV170
Nevada Injured Employee's Request for Compensation (D-6) StateFP FFNV200
Nevada Injured Employee's Right to Reopen a Claim Which Has Been Closed (D-13) StateFP FFNV250
Nevada Injured Worker Index System Claims Registration Document (D-38) StateFP FFNV365
Nevada Instrucciónes Y lnformación Para Hacer el reclamo (NUCS-4001SFI) StateFP FFNV075
Nevada Instructions for ES-8560 StateFP FFNV020
Nevada Instructions for ES-935 StateFP FFNV010
Nevada Instructions for NUCS-4172 StateFP FFNV040
Nevada Instructions for NUCS-4194 StateFP FFNV050
Nevada Instructions for NUCS-4360 StateFP FFNV065
Nevada Insurer's Subsequent Injury Checklist (D-37) StateFP FFNV360
Nevada Interest Calculation for Compensation Due (D-27) StateFP FFNV310
Nevada International Association of Industrial Accident Boards and Commissions POC 1 (D-41) StateFP FFNV375
Nevada Lump Sum Rehabilitation Agreement (D-29) StateFP FFNV320
Nevada Medical Statement (NUCS-4194) StateFP FFNV045
Nevada Notice of Claim Acceptance (D-30) StateFP FFNV325
Nevada Notice of Election for Compensation Benefits Under the Uninsured Employer Statutes (D-16) StateFP FFNV265
Nevada Notice of Injury or Occupational Disease (Incident Report) (C-1) StateFP FFNV180
Nevada Notice of Intention to Close Claim (D-31) StateFP FFNV330
Nevada Notice to Employees - Tip Information (D-22) StateFP FFNV285
Nevada Notice to Employees (Required Poster) (NUCS-4324) StateFP FFNV140
Nevada Occupational Disease Claim Report (OD-8) StateFP FFNV470
Nevada Permanent Partial Disability Award Calculation Worksheet (D-9a) StateFP FFNV215
Nevada Permanent Partial Disability Award Calculation Worksheet for Disability (D-9b) StateFP FFNV220
Nevada Permanent Total Disability Report of Employment (D-14) StateFP FFNV255
Nevada Petition for Trade Adjustment Assistance (ETA-8560) StateFP FFNV015
Nevada Physician's Progress Report - Certification of Disability (D-39) StateFP FFNV370
Nevada Policy Termination, Cancellation and Reinstatement Notice (D-50) StateFP FFNV410
Nevada Power of Attorney (NUCS-4556) StateFP FFNV145
Nevada Proof of Coverage Notice (D-48) StateFP FFNV400
Nevada Reaffirmation of Lump Sum Request (D-11) StateFP FFNV235
Nevada Rehabilitation Lump Sum Request (D-28) StateFP FFNV315
Nevada Reporting Form StateFP FFNV480
Nevada Request for a Rotating Rating Physician or Chiropractor (D-35) StateFP FFNV350
Nevada Request for Additional Medical Information and Medical Release (D-36) StateFP FFNV355
Nevada Request for Hearing - Contested Claim (D-12a) StateFP FFNV240
Nevada Request for Hearing - Uninsured Employer (D-12b) StateFP FFNV245
Nevada Request for Reimbursement of Expenses for Travel and Lost Wages (D-24) StateFP FFNV295
Nevada School Attendance Questionnaire (NUCS-4345) StateFP FFNV055
Nevada Sole Proprietor Coverage (D-45) StateFP FFNV390
Nevada Spanish Version: An Employee's Guide to Nevada Workers' Compensation Insurance StateFP FFNV465
Nevada Statement of Inactivity StateFP FFNV475
Nevada Statement to Correct - Continuation Sheet - Quarterly List of Tips and Wages (NUCS-4500T) StateFP FFNV160
Nevada Statement to Correct - Continuation Sheet - Quarterly List of Wages Reported (NUCS-4500) StateFP FFNV165
Nevada Statement to Correct - Tips (NUCS-4075T) StateFP FFNV155
Nevada Statement to Correct (NUCS-4075) StateFP FFNV150
Nevada Stop Pay Order and Affidavit of Lost or Destroyed Warrant (NUCS-4360) StateFP FFNV060
Nevada Temporary Partial Disability Calculation Worksheet (D-46) StateFP FFNV395
Nevada Unemployment Benefits Handbook StateFP FFNV080
Nevada Wage Calculation Form for Claims Agent's Use (D-5) StateFP FFNV195
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