Get University Of Hawaii A9720 Attachment 4 Form

Filling out the University Of Hawaii A9720 Attachment 4 Form is a critical step in ensuring accurate computation of average weekly wages for temporary disability payments. This guide will provide clear instructions to help you navigate the form effectively, ensuring that all necessary information is completed accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in the available online editor.
2. Begin by entering the name of the employee-claimant at the top of the form.
3. Next, provide the date of injury or illness in the designated field.
4. Fill in the regular salary or wage at the time of injury. Specify if the employee is a student assistant or casual hire by indicating the amount per month and per hour.
5. List the total earned wages for work performed during the prior 52 weeks below the salary section.
6. In the section that follows, account for any additional compensation received by the employee in the 52 weeks preceding the injury. Check the box if no additional compensation was received.
7. For each type of additional compensation (like overtime, differentials, etc.), enter the corresponding amounts next to each description provided in the form.
8. Ensure to total all amounts recorded to get a final figure for all compensations, noting any special items such as retroactive pay.
9. Respond to the inquiry regarding unpaid overtime and totals as needed.
10. If the employee was on a temporary assignment at a higher pay rate, indicate their regular rate of pay in the provided field if applicable.
11. Review the information entered for accuracy. Ensure all fields are completed as required.
12. The form can be saved, downloaded, printed, or shared as needed once all entries are confirmed.

Complete your forms online to ensure proper and timely submissions.