Publications and Forms

Individual Self Insured Employer Information Sheet (WC-131)

Current contact information to be submitted by self-insured employers on an annual basis and as needed.

 
Irrevocable Letter Of Credit (MODES-4354)
Letter from financial institution approving a line of credit for an employer.
 
Missouri Public Work Check-Off List (PW-5)

A checklist for public work projects compliance.

 
Missouri Unemployment Tax Information for 501(c)(3) Nonprofit Corporations (MODES-INF-389)

An informational brochure regarding unemployment tax information for 501(c)(3) Nonprofit Corporations regarding exemptions, voluntary election of coverage and reporting requirements.

 
Motion for Leave to Withdraw (WC-236)

A motion to withdraw an attorney in regards to a workers' compensation case.

 
Notice of Opening or Closure of Mines (LS-66)

A form to notify the Mine and Cave Safety Program when a Missouri mine or cave is opening or closing. Report Online

 
Project Notification - Contractor Information (PW-2)

A project notification containing contractor information.

 
Proposed Rates for Group Trust Self-Insurance (WC-127)

A form to submit proposed rates for a self-insured group trust.

 
Questions and Affidavit Regarding Benefit Sources and Payments - Affidavit Form A (WCT-2)

Questions and affidavit for claimant regarding benefit sources and payments, form A.

 
Questions and Affidavit Regarding Completeness of Medical Information Submitted - Affidavit Form E (WCT-6)

Questions and affidavit for claimant regarding completeness of medical information submitted, form E.