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Louisiana Forms

47 State Forms found

name	number	revision	print or send online
LOUISIANA WORKERS’ COMPENSATION SECOND INJURY BOARD POST‐HIRE/CONDITIONAL JOB OFFER KNOWLEDGE QUESTIONNAIRE	SIB Form D	(10/17)
MOTION FOR RECOGNITION OF RIGHT TO SOCIAL SECURITY OFFSET	LWC-WC-1005A	Rev. 7/08
NOTICE OF CLAIM WITH SECOND INJURY FUND	SIB Form A	No Form/Rev Date
NOTICE OF PAYMENT, MODIFICATION, SUSPENSION, TERMINATION OR CONTROVERSION OF COMPENSATION OR MEDICAL BENEFITS	LWC-WC-1002	No Form/Rev Date
ORDER RECOGNIZING RIGHT TO SOCIAL SECURITY OFFSET	LWC-WC-1005B	Rev. 7/07
LOUISIANA SECOND INJURY BOARD REQUEST FOR REIMBURSEMENT - FORM B	SIB Form B	3/17
EMPLOYEE’S MONTHLY REPORT OF EARNINGS (Spanish)	LWC-WC 1020	No Form/Rev Date
REQUEST FOR COMPROMISE OR LUMP SUM SETTLEMENT	LWC-WC-1011	REV. 07/08
REQUEST FOR INDEPENDENT MEDICAL EXAMINATION	LWC-WC 1015	REVISED 10/14
REQUEST FOR SOCIAL SECURITY BENEFITS INFORMATION	LWC-WC-1004	REVISED 7/8/08
REQUEST FOR WAIVER OF PAYMENT OF ADVANCE COSTS FACTS CONCERNING THE EMPLOYEE	LWC-WC 1027	Revised 1/1/98
SECURITY AGREEMENT FOR CERTIFICATE OF DEPOSIT	No Form Number	Last Revised 7/08/08
SELF-INSURANCE APPLICATION CHECKLIST	No Form Number	Undated Form
SERVICE COMPANY APPLICATION	LWC-WC-2007	No Form/Rev Date
SERVICE COMPANY APPLICATION CHECKLIST	No Form Number	Undated Form

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Disclaimer: These forms may not be the most recent version. Louisiana 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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