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Unemployment Insurance
Workers' Compensation
 
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Product Manufacturer SKU More Info
Texas / The Clerk: He / She Intends to Request Permission to the Division Spanish DWC054S StateFP FFTX295
Texas Accident Prevention Plan Cover Sheet DWC102 StateFP FFTX525
Texas Accident Prevention Services Annual Report DWC109 StateFP FFTX565
Texas Accident Prevention Services Worksheet DWC105 StateFP FFTX555
Texas Agreement Between General Contractor and Subcontractor to Establish Independent Relationship DWC085 StateFP FFTX035
Texas Agreement Between General Contractor and Subcontractor to Establish Independent Relationship DWC085S StateFP FFTX040
Texas Agreement Between General Contractor and Sub-Contractor to Provide Worker's Compensation DWC081 StateFP FFTX005
Texas Agreement Between the Contractor General and the Sub Contractor DWC081S StateFP FFTX010
Texas Agreement Dispute Benefits DWC025S StateFP FFTX085
Texas Agreement for Certain Building and Construction Workers DWC083 StateFP FFTX020
Texas Agreement for Certain Workers building and construction DWC083S StateFP FFTX025
Texas Agreement for Motor Carriers and Owner Operators DWC082 StateFP FFTX015
Texas Agreement to Benefit Dispute DWC024s StateFP FFTX075
Texas Application for Adjustment of an Average Weekly Wage (a) Employee / a Season DWC055S StateFP FFTX305
Texas Application for Attorney's Fees DWC152 - Cover StateFP FFTX660
Texas Application for Division Approval of Change in the Payment Period DWC031 StateFP FFTX100
Texas Application for Division Approval of the Purchase of an Annuity for Lifetime Income Benefit DWC035 StateFP FFTX120
Texas Application for Reimbursement from the Return-to-Work Account for Small Employers DWC008 StateFP FFTX510
Texas Application for Supplemental Income Benefits DWC052 StateFP FFTX270
Texas Application of the Texas Workers Injured About Advance Payment of Compensation DWC047S StateFP FFTX255
Texas Applications for a Texas Medical Appointed DWC032S StateFP FFTX110
Texas Attorney Application for Web Access DWC151 StateFP FFTX655
Texas Benefit Dispute Agreement cover sheet DWC024 StateFP FFTX070
Texas Benefit Dispute Settlement DWC025 StateFP FFTX080
Texas Carrier Representative Information Submission Form DWC027 StateFP FFTX095
Texas Carrier's Request for Reduction of Income Benefits Due to Contribution DWC033 StateFP FFTX115
Texas Carrier's Request for Seasonal Employee Wage Information from Texas Workforce Commission DWC056 StateFP FFTX310
Texas Certification and Approval of a Possible Job Spainsh DWC156S StateFP FFTX685
Texas Correction/Revision/Endorsement to Existing Policy DWC020A StateFP FFTX050
Texas Declaration of Employer's Salary Spanish DWC003S StateFP FFTX460
Texas Declaration of Multiple Jobs Salary Employee Spanish DWC003MES StateFP FFTX165
Texas Declaration of Salary To Schools District DWC003SDS StateFP FFTX470
Texas Designated Address StateFP FFTX945
Texas Documentary Irrevocable Standby Letter of Credit ("Confirmation") DWC224 StateFP FFTX870
Texas Documentary Irrevocable Standby Letter of Credit DWC223 StateFP FFTX860
Texas DWC Form-060S: Request for Dispute Resolution of Medical Fees DWC060S StateFP FFTX600
Texas Election to Engage in Arbitration DWC044 StateFP FFTX220
Texas Employee's Claim for Compensation for a Work-Related Injuries Disease DWC041S StateFP FFTX190
Texas Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease DWC041 StateFP FFTX180
Texas Employee's Election for Commuted (Lump Sum) Impairment Income Benefits DWC051 StateFP FFTX265
Texas Employee's Multiple Employment Wage Statement DWC003ME StateFP FFTX160
Texas Employee's Request for Acceleration of Impairment Income Benefits DWC046 StateFP FFTX240
Texas Employee's Request for Payment of Advanced Compensation DWC047 StateFP FFTX250
Texas Employee's Request To Change Treating Doctors - Non Network DWC053 StateFP FFTX280
Texas Employer Request for DWC Safety Consultation DWC104 StateFP FFTX540
Texas Employer's Contest of Compensability DWC004 StateFP FFTX475
Texas Employer's First Report of Injury or Illness (for state employees) DWC001S StateFP FFTX435
Texas Employer's First Report of Injury or Illness DWC001 StateFP FFTX430
Texas Employer's Notice of No Coverage or Termination of Coverage DWC005 StateFP FFTX480
Texas Employer's Report for Reimbursement of Voluntary Payment DWC002 StateFP FFTX440
Texas Employer's Wage Statement DWC003 StateFP FFTX445
Texas Employer's Wage Statement for School Districts DWC003SD StateFP FFTX465
Texas Exception to Application of Joint Agreement for Certain Building and Construction Workers DWC084 StateFP FFTX030
Texas Explanation of Benefits DWC062 StateFP FFTX610
Texas Implementation of the Employee Benefits for Supplemental Income Spanish DWC052S StateFP FFTX275
Texas Instructions For Completing The ADA J515 Dental Claim Form For Texas Workers' Compensation DWC070 StateFP FFTX630
Texas Insurance Carrier's Notice of Coverage/Cancellation/Non-Renewal of Coverage DWC020 StateFP FFTX045
Texas Locations of Employers' Business(es) DWC205 StateFP FFTX350
Texas Mass Claims Agreement Letter StateFP FFTX970
Texas Mass Claims Excel Spreadsheet and Instructions StateFP FFTX975
Texas Mass Claims Information StateFP FFTX955
Texas Maximum Medical Improvement/First Impairment Income Benefit Payment (124.2(e)(1)(4)&(5)) PLN03 StateFP FFTX720
Texas Medical Fee Dispute Resolution Request DWC060 StateFP FFTX595
Texas New Employee Notice - English StateFP FFTX355
Texas New Employee Notice - Spanish StateFP FFTX360
Texas New Employee Notice -English StateFP FFTX380
Texas New Employee Notice -Spanish StateFP FFTX385
Texas Non-ADL Doctor Request for Case-By-Case Exception DWC075 StateFP FFTX645
Texas Non-Covered Employer's Report of Occupational Injury and Illness DWC007 StateFP FFTX495
Texas Non-Covered Employer's Report of Occupational Injury and Illness, Supplement DWC 7 DWC007SUP StateFP FFTX345
Texas Notice 5 -English StateFP FFTX365
Texas Notice 5 Rules StateFP FFTX370
Texas Notice 5 -Spanish StateFP FFTX375
Texas Notice 6 -English StateFP FFTX390
Texas Notice 6 Rules StateFP FFTX395
Texas Notice 6 -Spanish StateFP FFTX400
Texas Notice 8 - Spanish StateFP FFTX410
Texas Notice 8 -English StateFP FFTX405
Texas Notice 9 - Spanish StateFP FFTX425
Texas Notice 9 -English StateFP FFTX415
Texas Notice 9 Rules StateFP FFTX420
Texas Notice of Denial of Compensability/Liability and Refusal to Pay (124.2(d)) PLN01 StateFP FFTX700
Texas Notice of Disputed Issues(s) and Refusal to Pay Benefits (124.2(h)) PLN11 StateFP FFTX800
Texas Notice of Fatal Injury or Occupational Disease and Claim for Compensation for Death Benefits DWC042 StateFP FFTX200
Texas Notice of Non-Coverage by Employer or Cancellation of Coverage Spanish (Form DWC-005s) DWC005S StateFP FFTX335
Texas Notice of Representation or Withdrawal of Representation DWC150 StateFP FFTX650
Texas Notice to Certified Self-Insured Employer Rules Notice StateFP FFTX925
Texas Notice to Employee: Intention to Request Division Permission to Adjust Benefits DWC054 StateFP FFTX290
Texas Notice to employees concerning Workers' Compensation in Texas English Notice StateFP FFTX915
Texas Notice to employees concerning Workers' Compensation in Texas Spanish Notice StateFP FFTX935
Texas Notification of Change in Amount of Indemnity Benefit Payment (124.2(e)(2)&(3)) PLN08 StateFP FFTX770
Texas Notification of Change of Indemnity Benefit Type (124.2(e)(4)) PLN07 StateFP FFTX760
Texas Notification of Employer Full Salary Payment (124.2(e)(7)) PLN06 StateFP FFTX750
Texas Notification of First Death Benefit Payment (124.2(e)(1)) PLN05 StateFP FFTX740
Texas Notification of First Lifetime Income Benefit Payment (124.2(e)(1)) PLN04 StateFP FFTX730
Texas Notification of First Temporary Income Benefit Payment (124.2(e)(1)) PLN02 StateFP FFTX710
Texas Notification of Reinstatement of Indemnity Benefit Payment (124.2(e)(5)) v StateFP FFTX790
Texas Notification of Suspension of Indemnity Benefit Payment (124.2(e)(6)) PLN09 StateFP FFTX780
Texas Parental Guaranty DWC226 StateFP FFTX890
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