Get Wy Wcd-9 2014

The WY WCD-9 form is essential for individuals seeking temporary total disability benefits due to extraordinary circumstances. This guide provides you with clear instructions on how to complete the form efficiently and accurately online.

Follow the steps to complete the WY WCD-9 form online.

1. Click ‘Get Form’ button to obtain the document and open it in your online editing tool.
2. Begin by entering your name in the designated field. Ensure that you print or type your name clearly for legibility.
3. Fill in your social security number. This is crucial for the processing of your application.
4. Provide your date of birth. Make sure to input the correct format for clarity.
5. Record the date of injury in the appropriate field. Accuracy here is important to establish eligibility.
6. Enter your complete address, including city, state, and zip code. This information helps in correspondence regarding your claim.
7. Input your phone number and email address. Ensure both are active and monitored as they may be used for communication.
8. Answer the eligibility questions regarding unemployment compensation, child support payments, and current work activities by selecting 'Yes' or 'No' as appropriate.
9. For those who answered 'Yes' to question four, provide specific dates of employment, stating whether it was part-time or full-time, and include a brief description of the work performed.
10. Sign and date the form to affirm your application and claim for benefits. This includes understanding the terms concerning false information and the release of your medical information.
11. For the health care provider’s section, ensure your health care provider clearly completes all required fields, including their signature and date, certifying your temporary total disability.
12. Review all completed sections for accuracy and completeness before finalizing your form.
13. Once the form is complete, save any changes made, and proceed to download, print, or share the form as required.

Start filling out your WY WCD-9 form online to secure your benefits today.