Get Nc Form 22 2020-2025

Filling out the NC Form 22 is an essential step for employers providing the days worked and earnings of an injured employee under the Workers' Compensation Act. This guide offers a detailed explanation and step-by-step guidance on how to complete this form online efficiently.

Follow the steps to complete the NC Form 22 online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the employee’s name and the employer's name along with their respective addresses and telephone numbers. Ensure that all details are accurate to prevent any issues during processing.
3. Fill in the employee's Social Security Number (last four digits) and date of injury. Make sure to include the correct day, month, and year.
4. Indicate the employee's sex and date of birth, providing correct and up-to-date information.
5. Document the insurance carrier information, including the carrier’s name, address, and contact numbers. This is crucial to ensure proper communication and documentation.
6. Record the monthly earnings for each month of the year in the appropriate columns. If any changes in job or pay rate occurred during this period, make a note of them.
7. Ensure to mark days when the employee was fully paid with an 'X' and leave blank spaces for any unpaid days. Mark paid vacation or sick leave according to the guidelines.
8. Complete the certification section by filling in the date of the injury and the authorized signature. Ensure the form is signed and dated appropriately.
9. After verifying all information is correct, save your changes. You may choose to download, print, or share the completed form as needed.

Complete your documentation online today to ensure a smooth filing process.