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Publications and Forms

Power of Attorney (MODES-4444)

A form authorizing power of attorney to a business representative.

Prevailing Wage Complaint Form (PW-6)

A complaint form regarding Missouri prevailing wage. File online today!

Public Administration Data Sheet (LS-81)

Analyzing workplace injuries in the Public Administration sector.

Quarterly Client List (MODES-4282)

An employer ("lessor") leasing workers to other businesses ("clients") uses the Quarterly Client List to inform the Division of new and former clients. The Division uses the form to maintain responsibility for unemployment tax filing. The Quarterly Client List must be filed by the lessor each quarter per Missouri labor regulations.

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.