Get Cc Form

The Cc form is a crucial document used to report compensation paid or suspended for employees within the Oklahoma Workers' Compensation system. This guide provides clear, step-by-step instructions to help users complete the form online effectively.

Follow the steps to complete the Cc Form accurately.

1. Press the ‘Get Form’ button to access the Cc Form and open it in your preferred online editor.
2. Begin by entering the commission file number at the top of the form. This helps identify your report distinctly.
3. Fill out the employee's full name, including their last name, first name, and middle initial. This ensures that the report is accurately attributed to the right individual.
4. Provide the employee's social security number, inputting the last four digits only to protect privacy.
5. Complete the sections detailing the employer's name and carrier or self-insured name, including the city, state, and zip code associated with the claims office location.
6. In the disability information section, specify the date of injury, the last day the employee worked, and the date the employee was able to return to work (RTW). Also, calculate and input the total days worked between the injury and the RTW date.
7. Detail the compensation payments made, including the numbers of weeks and days for temporary total disability (TTD), temporary partial disability (TPD), and permanent partial disability (PPD), along with any hospital, medical, drugs, or other related expenses.
8. If applicable, fill in information about the suspension of payments, including the date of suspension and the reason for it.
9. Certify the report by signing, printing or typing your name, including your title and date, to affirm the accuracy of the provided information.
10. Once all sections are filled out, review the document for accuracy. You can save your changes, download, print, or share the form as needed.

Complete your Cc Form online to ensure accurate reporting of compensation.