Get 97-22 Through 24) - Ncdps

Filling out the 97-22 THROUGH 24) - Ncdps form is an essential step for employees who have sustained an injury or contracted an occupational disease. This guide will provide you with a comprehensive, step-by-step process to complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the IC File number, which serves as the unique identifier for the injury, provided in a return letter. It is crucial to reference this number in all future correspondence.
3. Fill in the employee’s name, Social Security number, and date of birth. Make sure the information is accurate and reflects the details as per official documents.
4. Provide the employer's name and address, including city, state, and zip code. This information is vital for corresponding regarding the claim.
5. Fill in the details of the insurance carrier, including their policy number, address, and contact number. Ensure this information is current and correct.
6. Indicate the date and time of the injury, the location where it occurred, and describe the nature of the injury or occupational disease in detail.
7. Specify your occupation at the time of the injury and provide information about the employer’s business. This includes the number of days out of work due to the injury and if you have received medical treatment.
8. Complete the section about your weekly wage, number of hours worked per day, and days worked per week.
9. If the employee is unable to sign the form, allow another person to sign on their behalf. Ensure this section is completed accurately.
10. Review all entries for accuracy, save your changes, and proceed to print or share the completed form as needed. Retain one signed copy for your records.

Complete and submit your documents online to ensure timely processing of your claim.