Get Tx Dwc052 2009-2025
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How to fill out the TX DWC052 online
The TX DWC052 form is an essential document for employees applying for Supplemental Income Benefits in Texas. Filling it out accurately is crucial to ensure a smooth application process and to avoid delays in receiving benefits.
Follow the steps to complete the TX DWC052 form online.
- Click ‘Get Form’ button to obtain the TX DWC052 and open it in your editor.
- In Section 1, provide your employee information. This includes your name, Social Security Number, telephone number, date of injury, mailing address, current treating doctor’s name, and their telephone number.
- In Section 2, enter employer and insurance carrier information. Fill in the employer's name, the insurance carrier's name, the adjuster's name, and their telephone number.
- Section 3 focuses on SIBs qualifying information. You will need to provide your impairment rating, the date of maximum medical improvement, the quarter number, filing deadline, dates of the quarter, dates of the qualifying period, county of residence, and the number of minimum weekly work search efforts required for your county.
- In Section 4, document your work search activities. Use the detailed job search/employer contact log provided in the form, checking all applicable boxes related to your work search efforts, and indicate the number of searches conducted.
- Section 5 requires you to record wages earned during the qualifying period. Enter the week ending dates and corresponding gross wages earned for each week.
- In Section 6, certify that all information provided is accurate. Sign and date the form to complete this section.
- Section 7 will be completed by the TDI-DWC or the insurance carrier regarding your entitlement to supplemental income benefits. Wait for their notification after your application is processed.
- Once all sections are completed, save your changes. You can then download, print, or share the form as required.
Start filling out the TX DWC052 online today to apply for your Supplemental Income Benefits.
To file an open records request in Texas, you need to submit a written request to the relevant governmental body. Be specific about the information you seek to facilitate the process. It is advisable to review the guidelines associated with the TX DWC052, especially if your request involves workers' compensation records. For more detailed instructions and examples, US Legal Forms provides helpful resources to aid your request.
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