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Nevada Forms

14 State Forms found

name	number	revision	print or send online
APPLICATION FOR REIMBURSEMENT OF CLAIM RELATED TRAVEL EXPENSES	D-26	Rev. 4/04
ELECTION OF LUMP SUM PAYMENT OF COMPENSATION	D-10a	(Rev. 2/23)
EMPLOYEE'S CLAIM FOR COMPENSATION - UNINSURED EMPLOYER	D-17	(rev.09/24)
EMPLOYEE'S CLAIM FOR COMPENSATION/REPORT OF INITIAL TREATMENT	Form C-4	(rev.02/25)
EMPLOYEE'S DECLARATION OF ELECTION TO REPORT TIPS For the Purpose of Workers' Compensation	D-23	rev. 7/99
EMPLOYER'S WAGE VERIFICATION FORM	D-8	(rev 11/23)
EXPLANATION OF WAGE CALCULATION	D-7	rev. 7/99
INJURED EMPLOYEE'S REQUEST FOR COMPENSATION	D-6	Rev. 7/99
INTEREST CALCULATION FOR COMPENSATION DUE	D-27	(rev.7/99)
NOTICE OF ELECTION FOR COMPENSATION BENEFITS UNDER THE UNINSURED EMPLOYER STATUTES	D-16	rev. 05/2018
REAFFIRMATION/RETRACTION OF LUMP SUM REQUEST	D-11	rev. 8/21
REHABILITATION LUMP SUM REQUEST	D-28	rev. 7/99
REQUEST FOR REIMBURSEMENT OF EXPENSES FOR TRAVEL AND LOST WAGES	D-24	rev. 6/2006
WAGE CALCULATION FORM FOR CLAIMS AGENT'S USE	D-5	(rev. 7/99)

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