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Publications and Forms

Quarterly Contribution and Wage Report (MODES-4)

Employers use the Quarterly Contribution and Wage Report to report wages of their employees to the Division of Employment Security. Each liable employer is required to file this report each quarter even if it has paid no wages that quarter or if its assigned tax rate is zero.

Report of Injury (WC-1-EDI)

A form to be completed by the insurance company or third party administrator in the event of worker injury or death.

Report Worker Misclassification/1099 Abuse (MODES-4610)

Report worker misclassification/1099 abuse.

Request for Award on Undisputed Facts in Regard to Application for Payment of Additional Reimbursement of Medical Fees (WC-297)

A request by an employer or insurer for an award on undisputed facts in regard to application for payment of additional reimbursement of medical fees on the ground that the Application was not filed within the limitation period set forth in §287.140.4, RSMo, or that the charges were paid in full or any ground that negates liability for payment.

Request for Pre-Hearing (WC-183)

Request to DWC for a pre-hearing regarding workers compensation claim.

Request for Wage Determination (PW-3)

A form to request a wage determination according to Chapter 290 RSMo.

Resource Guide for Employers (MODOL-4466)

A resource guide for employers containing information about unemployment insurance, workers' compensation, wage and hour standards, discrimination, FMLA, youth employment laws, mine and cave safety, and federal requirements.

Salario Mínimo de Missouri requiere del cartel (LS-52-S)

Cartel para colgar en el lugar de trabajo a Missouri salario mínimo.

Self-Insuring Workers' Compensation Liability Through Trusts (WC-124)

This brochure is to inform employers who are or want to be self-insured for workers' compensation liability through trusts (a way employers that are usually within the same industry or members of the same association can pool their liabilities with other employers).

Shared Work Plan Application (MODES-SW-1)

Apply for the Shared Work Program, an alternative to laying off your employees!