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.

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.

Notice of Opening or Closure of Mines (LS-66)

A form to notify the Mine and Cave Safety Program when a Missouri mine or cave is opening or closing. Report Online

Project Notification - Contractor Information (PW-2)

A project notification containing contractor information.

Proposed Rates for Group Trust Self-Insurance (WC-127)

A form to submit proposed rates for a self-insured group trust.

Questions and Affidavit Regarding Benefit Sources and Payments - Affidavit Form A (WCT-2)

Questions and affidavit for claimant regarding benefit sources and payments, form A.

Search Forms & Publications

Search by form number, title, or keyword

Filter by Division

Filter by Type

Filter by Topic

Items per page

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)

How to fill and sign a PDF form

1. Open a PDF document in Adobe Acrobat DC. If you don’t have the latest version of Adobe Acrobat DC, download it for free from Adobe’s site: https://get.adobe.com/reader/

2. Click the “Fill & Sign” tool in the right pane.

3. Fill out your form: Complete form by clicking a text field and typing or adding a text box. You can add checkmarks and fill in radio buttons too.

4. Sign your form: Click “Sign” in the toolbar at the top of the page. Then draw, type, or choose an image for your signature. Then click “Apply” to place your signature on the form.

5. Send your form: After you have filled the form, you can save the PDF and send it to others.

Note: When you save a form with a signature or initials, you will no longer be able to edit the existing form fields.

Publications and Forms

By Division

Explore By Topic