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Publications and Forms

Application for Review to the Labor and Industrial Relations Commission (MOIC-2567)

An application to have an award, decision or order reviewed by the LIRC.

Applying for Unemployment Insurance Benefits (MODES-4713)

A checklist for unemployed workers on how to apply for benefits.

Are You Off the Books? 1099 Fraud - Worker Misclassification (MODES-4714)

Information related to 1099 Fraud - Worker Misclassification, including consequences, online-assessment and tip reporting.

Aviso a los trabajadores sobre las prestaciones por desempleo (MODES-B-2-S)

Un cartel para colgar en un lugar de trabajo notificar a los empleados sobre los beneficios de desempleo.

Certificate to Employ a Child 14 or 15 Years of Age During Non-School Term (LS-68)

Certificate to employ a child age 14 or 15 during summer months. 

Certificate to Employ a Child 14 or 15 Years of Age During School Term (LS-67)

Certificate to employ a child age 14 or 15 during school months.

Claim for Compensation (WC-21)

A form to be completed by the injured worker or by his or her attorney when making a claim for workers' compensation for injuries occurring prior to January 1, 2014.

Claim for Compensation (WC-21-A)

A form to be completed by the injured worker or by his or her attorney when making a claim for workers' compensation for injuries occurring on or after January 1, 2014, based upon the revisions to the Workers’ Compensation Law made by Senate Bill 1.

Claim for Compensation for Line of Duty Compensation Benefits (WCLoD-1)

A claim to be filed regarding a payment to the estate of an Air Ambulance Pilot, an Air Ambulance Registered Professional Nurse, an Emergency Medical Technician, a Firefighter, or a Law Enforcement Officer who was killed in the line of duty.

Claimant Records Release Authorization (MODES-4384)

An authorization for the release of claimant records.

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