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Publications and Forms

Health Care Provider's Response to Request for Award on Undisputed Facts in Regard to Application for Direct Payment (WC-202)

A health care provider’s response to a request for an award on undisputed facts in regard to an application for direct payment medical fee dispute.

Individual Self Insured Employer Information Sheet (WC-131)

Current contact information to be submitted by self-insured employers on an annual basis and as needed.

Irrevocable Letter Of Credit (MODES-4354)

Letter from financial institution approving a line of credit for an employer.

Irrevocable Letter Of Credit Regulation (C-248)

Regulation 8 CSR 10-4.170 establishing procedures for complying with the irrevocable letter of credit aspect of section 288.032(2) RSMo.

Lessor Employing Unit/Client Lessee Law (MODES-4267)

The Division of Employment Security may consider an employer who provides, or "leases", employees to another business to be a "lessor employing unit". The business to whom the employees are provided is termed a "client lessee".

The Missouri Employment Security Law states that a lessor employing unit will be responsible for reporting all wages paid and be liable for contributions (tax) due on the wages paid.

  1. The lessor employing unit has the option to make a financial guarantee to the Division to pay contributions due. The lessor may guarantee payment by posting and maintaining a surety bond, depositing securities, providing an irrevocable letter of credit, or obtaining a certificate of deposit. This action will relieve the lessor's clients of any liability. It will also allow the lessor to report all employees on one quarterly return.
  2. If the lessor does not make a financial guarantee to the Division that contributions will be paid, the client lessee will be jointly liable for contributions due on wages paid to the employees provided to it. In order to identify the employees provided to each client lessee, the lessor must file a separate quarterly return for each client lessee.

    To maintain correct records, the Division requires the lessor to submit a quarterly list of its clients.

    NOTE: The above provisions do not apply to private employment agencies who provide their employees to others on a temporary help basis.

Lessor Employing Units Regulation (MODES-4281)

State regulation for lessor employing units.

Missouri Public Work Check-Off List (PW-5)

A checklist for public work projects compliance.

Missouri Unemployment Tax Information for 501(c)(3) Nonprofit Corporations (MODES-INF-389)

An informational brochure regarding unemployment tax information for 501(c)(3) Nonprofit Corporations regarding exemptions, voluntary election of coverage and reporting requirements.

Motion for Leave to Withdraw (WC-236)

A motion to withdraw an attorney in regards to a workers' compensation case.

Noncompliance Referral Form (WC-258)

Complete the form to report a business for not carrying workers' compensation insurance.

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