The Pennsylvania Statement of Wages (For Injuries Occurring On Or Before June 23, 1996) is a form issued by the Pennsylvania Department of Labor and Industry that is used to report the wages of employees who have been injured on the job. It is used to determine the amount of compensation to be paid out to an injured worker. The form includes information such as the employee’s name, address, date of injury, wage rate, total wages earned, and any deductions taken. There are three types of Pennsylvania Statement of Wages (For Injuries Occurring On Or Before June 23, 1996): Form LIBC-717, Form LIBC-717A, and Form LIBC-717B. Form LIBC-717 is used to report the wages of employees who have been injured on or before June 23, 1996. Form LIBC-717A is used to report the wages of employees who have been injured after June 23, 1996. Form LIBC-717B is used to report the wages of employees who have been injured after June 23, 1996, and who are currently receiving workers’ compensation payments.