| Missouri Department of Labor and Industrial Relations

Application for Certification (WSP-45)

An application for certification by an insurance carrier writing workers' compensation in the state of Missouri.

Application for Membership (WC-81B)

Form to be used by employers applying for membership in a group trust.

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.

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.

Bi-Weekly Report on Physical Rehabilitation (WCR-5A)

A form for bi-weekly reporting on physical rehabilitation

Busy Seasons Mean More Distractions (LS-95)

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.

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Frequently Requested Forms

Claim for Compensation (Workers' Comp.)
Quarterly Contribution and Wage Report (Employment Security)
Contribution & Wage Adjustment Report (Employment Security)
Disability Schedule and Benefit Limits (Workers' Comp.)
Certificate to Employ a Child 14 or 15 Years of Age During School Term
Certificate to Employ a Child 14 or 15 Years of Age During Non-School Term
Missouri Minimum Wage Poster
Request for Mediation (Workers' Comp.)
Request for Pre-Hearing (Workers' Comp.)
Information for Workers (Employment Security)
Employers' Rights and Responsibilities (Employment Security)

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