Get Arkansas Workers Compensation A 29from N Form

Completing the Arkansas Workers Compensation A 29from N Form online can streamline the process of reporting wage information for an injured employee. This guide will provide step-by-step instructions to help you navigate the form effectively, ensuring accuracy and compliance.

Follow the steps to complete your form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by filling out the section for the wage statement immediately preceding the injury date. Input the weeks worked, straight time hours, and wages paid for straight time.
3. Enter the overtime hours worked, including days and wages paid for overtime.
4. Provide the Arkansas Workers Compensation Commission number, a detail essential for processing.
5. Fill in the carrier claim number to link your submission with the relevant insurance.
6. Input the employee's name and Social Security number accurately in the designated fields.
7. Include the employer's name and Federal Employer Identification Number (FEIN), which is crucial for identification.
8. Indicate the name of the insurance carrier or self-insured entity, followed by their National Association of Insurance Commissioners (NAIC) number.
9. In the instructions for completing the wage statement, if the claimant receives less than maximum benefits, ensure to specify details of time lost by the employee.
10. Finally, review all information for accuracy. Once confirmed, you can save your changes, download a copy, or print the form for submission.

Complete your documents online and stay compliant with your filing requirements.