This form must be completed and filed with the Commission in all cases resulting in death unless maximum compensation rate is stipulated. It must also be filed in any other case if there is a disagreement about earnings or if the Commission requests it.

All current forms used by the NC Industrial Commission can be found here. Most are in PDF format and will require Adobe Reader to view or print. Some forms may be filled and printed for submission electronically, per Rule 11 NCAC 23A .0108.

Access to Temporary Solutions Organizational Units in the Integrated HR-Payroll System is available to help agency customers complete Verifications of Employment (VOEs), the NC Industrial Commission Form 22, and other documents related to the employment of their temporaries through Temporary Solutions.

North Carolina Industrial Commission Form 22 is the Statement of Days Worked and Earnings of Injured Employee. This form contains a table wherein the hours worked and wages earned over the 52 weeks prior to the employee’s injury are recorded.

A Form 22 should be filed by any taxpayer who: • Has a name or address change; • Needs to correct, cancel, reinstate, or change a Nebraska tax certificate, license, or permit;

Pursuant to section 110 of the Children’s Act, 2005, and for purposes of section 114(1)(a) of the Act, you are hereby advised that a child has been abused in a manner causing physical injury/ sexually abused/ deliberately neglected or is in need of care and protection.

Use VA Form 22-1995 to request changes to your education benefits if one of these is true for you: You’re a Veteran or service member, or You’re a dependent of a Veteran or service member using Fry Scholarship benefits, Survivors’ and Dependents’ Educational Assistance (DEA) benefits, or transferred Post-9/11 GI Bill benefits

The SR-22 form is commonly required in many states for drivers who have been convicted of offenses such as DUI, driving without insurance, or multiple traffic violations. Essentially, an SR-22 is a certificate of insurance that proves a driver has the minimum required auto insurance coverage mandated by the state.

Recognizing and Reporting Child Abuse: Training for Mandated Reporters, available 24 hours a day, seven days a week.

Note 1 : This Form shall be issued with the signature of the manufacturer or importer or registered association, in case of E-rickshaw or E-cart duly printed in the Form itself by affixing facsimile signature in ink under the hand and seal, as applicable.