A form for use by health care provider applying for payment of additional reimbursement of medical fees in a workers’ compensation medical fee dispute —if a partial payment has been made. (These are called “reasonableness” cases.)

 

An application for tort victims compensation.

 
Some employers (\"lessors\") lease employees to clients. Unless the lessor provides a financial guarantee, such as posting securities, to ensure prompt payment of unemployment liabilities: (1) the lessor must file a separate Quarterly Contribution and Wage Report for the employees leased to each client; and (2) the client is jointly liable for the contributions otherwise due on the workers it leases from the lessor. MODES-4251 must be used for the posting of securities.
 
A form to authorize the release of confidential information for irrevocable letter of credit.
 

An authorization form to inspect and/or copy medical records pertaining to a workers’ compensation case.

 

This form allows a job applicant to grant a prospective employer access to the job applicant’s workers’ compensation record in Missouri.

 

The Missouri Revised Statutes regarding Child Labor.

 

The Common Paymaster Application is completed by a business that wishes to report the workers of a related business under its own account number. The Division of Employment Security will use the information provided on the application to either approve or deny the request for Common Paymaster reporting. To qualify:



  1. The businesses involved must be corporations or limited liability companies taxed as corporations.

  2. The entities must be related.

  3. The workers reported by the Common Paymaster must perform service for two or more of the related corporations during each calendar quarter.

 
Missouri Employment Security Law - Section 288.090 RSMo.
 

A checklist for a contractor on a public works projects to be in compliance.