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  • Wyoming Employeess Application For Temporary Total Disability Benefits Form

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CLAIM NUMBER: ADDRESS: DATE OF BIRTH: CITY, STATE, ZIP LAST 4 DIGITS OF SOCIAL SECURITY NUMBER: IS THIS A NEW ADDRESS? DATE OF INJURY: PHONE NUMBER: YES NO 1. ARE YOU WORKING OR HAVE YOU WORKED PART-TIME OR FULL TIME SINCE THE DATE OF YOUR INJURY IN A JOB OR SELF-EMPLOYMENT THAT IS ORDINARILY DONE FOR PAY? YES NO 2. HAVE YOU ASKED YOUR EMPLOYER FOR SUITABLE DUTIES THAT ACCOMMODATE YOUR PHYSICAL CONDITION? YES NO 3. ARE YOU RECEIVING UNEMPLOYMENT INSURANCE COMPENSATION? YES NO 4. ARE YO.

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You must be totally or partially unemployed through no fault of your own, and you must have earned sufficient wages in your base period (the first 4 of the last 5 completed calendar quarters before the week in which you file your application for benefits). Also, you must be able and available for full-time work.

Name, address, and phone number for your most recent employer. Date of the last day you worked. For any work completed outside of Wyoming over the previous 18 months, contact information and dates for those employers and periods of work. Your Social Security number.

Documents You Will Need For example, you can usually verify your identity by presenting your current Driver's License or State ID, along with a utility bill and Social Security Card. Keep in mind, you may need to provide additional documentation: If your name has changed. To prove your Social Security number.

You can get workers' compensation from the Wyoming Department of Workforce Services and find information about their workers' comp coverage on their website. It's also important to note that state monitor advocates can help farm workers ensure they're covered by workers' compensation.

You can file a claim for the week prior every Sunday, claims and payments are typically processed within 2 business days.

You will not be paid benefits for that week if your earnings equal or exceed your weekly benefit amount or if you work 35 or more hours that week. If you fail to report earnings or other compensations properly you could be disqualified from receiving benefits for 52 weeks.

Temporary Total Disability benefits are the equivalent of 2/3 of your gross monthly wage at the time of injury, but cannot exceed the Statewide Average Wage for the quarter you were injured. Temporary Total Disability benefits are not taxable.

Any business conducting work in the State of Wyoming or hiring a Wyoming resident as an employee must register with the Division of Workers' Compensation and Unemployment Insurance to have the coverage determined.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232