This report, as required by §287.680 RSMo, briefly describes each of the programs and units and summarizes the transactions and proceedings undertaken for the year 2015.
A profile of the master trading partner including contact information.
Missouri specific requirements to supplement the International Association of Industrial Accident Boards and Commission (IAIABC) Electronic Data Interchange.
A form for self-insured, self-administered employers, insurance companies or third-party administrators regarding electronic data interchanges (EDI) project agreement.
A Missouri electronic transmission profile receiver's specifications.
Information regarding the secure file transfer protocol (FTP) for the transmission of electronic data interchange (EDI) transactions.
A list of insurers for a sender's trading partner profile.
This booklet contains instructions and file specifications for electronic payments via ACH Credit to the Missouri Division of Employment Security.
This form must be used by the Workers' Compensation Insurance Carriers, the Self-Insured Employers and the Self-Insured Groups or trusts who would like to make Second Injury Fund surcharge payments to the Missouri Division of Workers' Compensation through an Electronic Fund Transfer.
The form to be completed by an employee request to be exempt from workers' compensation due to religious reasons.
The affidavit to be completed by an employee request to be exempt from workers' compensation due to religious reasons.
The affidavit to be completed by an employer when requesting for an employee to be exempt from workers' compensation due to religious reasons.
An Escrow Agreement; one of three options available to meet the self-insurance security requirement.
The checklist of required items and information that must accompany the Application for Self-Insurance Trust (WC-81A).
A guaranty of a third party to satisfy an individually self-insured employer’s workers’ compensation obligations under Missouri law.
Information for Appeals Tribunal hearings, including what they are, instructions, and other important facts to know.
This form allows attorneys that are parties to a case to jointly submit a motion for change of venue. All parties must agree to the change of venue.
A form to be completed by physician examining a workers compensation eye injury.
The Division uses the Quarterly Wage Report Continuation Sheet to allow reporting of additional employees when there are more employees than will fit on the Quarterly Contribution and Wage Report (MODES-4). This form MODES-10B should be attached to the MODES-4.
Instructions for completing the application, affidavit and waiver of workers compensation benefits.
Information regarding employees who wish to be exempt from workers' compensation law because of religious reasons.
This form allows employees to provide proper written notification to their employer when a workplace injury/occupational disease occurs.
The form to be completed by an employee who is requesting a rescission from a previously received religious exemption.
A self-evaluation questionnaire to be completed by an unemployed claimant.
A sample of by-laws that may be used as a reference when forming a new group trust.
Certification procedures for a self-insured group trust’s safety program.
Employers use the Social Security Number Correction form to correct the social security number of an employee whose number was erroneously reported. Employers may correct the social security number of one employee on each correction form, but the form may be applicable to more than one calendar quarter. After making the correction, please return to:
Division of Employment Security
Attn: Employer Accounts Unit
P. O. Box 59
Jefferson City, MO 65104-0059
or it can be faxed to 573-751-9705.
This application is to be completed by an employer that would like to request termination of coverage. Please see the form to learn the necessary qualifications for your specific employer type. This form is effective January 1st and must be filed by February 10th of the year with respect to which the termination is to be effective.
Information about Trade Adjustment Assistance for workers who have lost their job due to foreign trade.
This document is used by employers reporting quarterly contribution and wage information via magnetic media. It lists all the information necessary for the submission and processing of the quarterly magnetic media reports. Effective January 1, 2008, the Division will not accept quarterly unemployment insurance wages on a tape cartridge. Effective July 1, 2012, the Division will not accept quarterly unemployment insurance wages on diskette. Wages may be submitted on the Internet or on a compact disc.
A quick reference guide for employers and employees regarding wage and hour standards in Missouri.