Get Employers Wage Verification Form Nv

Filling out the Employers Wage Verification Form in Nevada is an important step for verifying wage loss due to crime-related injuries. This guide will provide you with clear, step-by-step instructions to ensure accurate completion of the form online.

Follow the steps to successfully complete the Employers Wage Verification Form

1. Click ‘Get Form’ button to access the Employers Wage Verification Form and open it in your preferred online editor.
2. Begin by filling out the Employee Information section, which requires the employee's name, the last four digits of their Social Security Number, and the VOCP Claim Number.
3. Next, complete the Employer Information section. This includes the employer's name, phone number, mailing address, fax number, and city, state, and zip code.
4. In the Employee Lost Time Information section, indicate whether the employee missed work due to crime injuries by selecting 'Yes' or 'No.' If 'Yes,' provide the first date not worked and whether the employee has returned to work, along with the return date.
5. If the employee did not return to work, check the appropriate reason: either still off work due to injuries or no longer employed with the employer.
6. Proceed to the Employee Hours and Wage Loss Information section. Enter the number of hours worked per day, week, pay period, or any other relevant period.
7. Specify the amount paid (hourly, daily, weekly, or other) and total that amount of wages lost by the employee due to crime injuries.
8. Indicate if the employee received other compensation, such as tips or bonuses, and if so, state the average daily additional compensation.
9. In the Employee Insurance Information section, indicate whether the employee had medical insurance coverage at the time of the crime, and if applicable, provide the name of the insurance carrier or union.
10. If the employee is deceased, indicate whether life insurance benefits were paid to beneficiaries and provide the relevant details.
11. Finally, an authorized person must certify the information by providing their signature, printed name, title, date, telephone number, and email address.
12. Once completed, users can save changes, download, print, or share the Employers Wage Verification Form as necessary.

Complete the Employers Wage Verification Form online for accurate and timely submission.