Get Tx Dwc047 2017-2025

The TX DWC047 form, also known as the Employee’s Request for Advance of Benefits, is a crucial document for individuals seeking advances on their workers' compensation benefits. This guide will provide you with clear and comprehensive instructions on how to effectively complete the form online, ensuring you can submit your request without any issues.

Follow the steps to fill out the TX DWC047 form online

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Enter the employee's name in the first section, ensuring you provide the first, middle, and last names accurately.
3. Input the last four digits of the employee's Social Security Number in the appropriate field.
4. Fill in the employee’s mailing address, including street or PO box, city, state, and zip code.
5. Provide the employee’s telephone number, including area code.
6. If applicable, include the name of the attorney or representative advocating for the employee.
7. Input an alternate telephone number if one is available.
8. Specify the date of injury using the mm/dd/yyyy format.
9. Enter the attorney or representative’s address if there is one.
10. In the employer information section, fill in the employer's name and address at the time of the injury.
11. Provide the insurance carrier's name and address in the specified fields.
12. Input the adjuster's name and telephone number, including extension, if applicable.
13. Enter the adjuster's fax number if available.
14. In the advance request section, specify the amount of advance requested.
15. Detail the amount of income benefits currently being received, indicating whether it is received weekly or monthly.
16. Indicate the maximum weekly/monthly reduction requested to pay back the advance.
17. Select the type of income benefits currently being received from the options provided.
18. Provide the length of time your doctor expects you to be off work, including the expected return date.
19. Explain the financial hardship that justifies the request for an advance of income benefits, attaching any necessary documentation.
20. Read the employee certification statement carefully and acknowledge understanding by signing in the required field.
21. Finally, save your changes, download, print, or share the completed form as needed.

Begin your process to complete the TX DWC047 online today.