benefits, you must file a corrected Form DWC-1a (Wage Statement) with your claims-handling entity within 7 days of such termination, reflecting the type and amount of fringe benefits that were paid, and the last date they were

Wage Statement (Form DFS-F2-DWC-1a) The Wage Statement must be completed on claims involving lost time from work. Please contact our claims department if you have questions about completing the Wage

Click the tabs below to see forms related to each chapter of Division 69L (Workers' Compensation) of the Florida Administrative Code. To access the interactive form, right click the link. Select "save target as" to save the form in your personal files. Macros MUST be "enabled".

DWC-1 Purpose and Use Statement . The collection of the social security number on this form is . specifically authorized by Section 440.185(2), Florida Statutes. The social security number will be used as a unique identifier in Division of Workers' Compensation database systems for individuals who have claimed benefits under

If you discontinue providing any fringe benefits, you must file a corrected Form DWC-1a (Wage Statement) with your claims-handling entity within 7 days of such termination, reflecting the type and amount of fringe benefits that were paid, and the last date they were provided. DO NOT combine wages of two or more employees. Saturday.

Forms. (1) The following forms are to be used with this rule chapter and are hereby incorporated by reference: (a) Form DFS-F2-DWC-1 3/16/09 First Report of Injury or Illness (b) Form IA-1 1/1/02 Workers’ Compensation First Report of Injury or Illness For use only by entities approved to transmit electronic First Reports of Injury to the Division (c) Form DFS-F2-DWC-1a 3/16/09 Wage Statement ...

DWC-1a Wage Statement Please follow the attached instructions when completing the DWC1a.

2011年9月25日 · Wage Statement (DFS-F2-DWC-1a) This form is not prepared or signed by the injured worker. It contains the employee’s wage information in order to calculate his/her average weekly wage (AWW). If applicable, the 13 week period immediately preceding the accident will be used to derive the AWW.

DWC-1a form to the claim administrator within 14 days of the employer’sknowledge of a Lost-Time or a medical to Lost-Time case •The whole of 13 weeks of the injured worker’swages immediately preceding the date of