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Case. Attached is a lien form. Complete the form. Be sure to sign and date it. This form can also be completed at http://www.dir.ca.gov/dwc/FORMS/EAMS%20Forms/ADJ/DWCForm6.pdf. Attach a full statement or itemized bill supporting the lien. A Workers Compensation Appeals Board (WCAB) case number must be entered in the top right hand corner of the lien. If there is no WCAB case number, contact the local Information & Assistance (I&A) office. Send copies to your local WCAB office and to all the p.

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