 POLITICAL SUBDIVISION WORKERS' COMPENSATION ALLIANCE FORMS
Mail or fax these forms to:
TAC WC Claims Unit
P.O. Box 160120
Austin TX, 78716
FAX: 512-346-9321 |
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Initial Notice Direct Contracting Packet |
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Treating Doctor Selection Form |
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Referral to Provider not Contracted with the Alliance |
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Change of Treating Doctor Form |
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 GENERAL WORKER'S COMPENSATION FORMS
Mail or fax these forms to:
Texas
Association of Counties
Attn: Workers' Compensation
Dept.
1210 San Antonio
Austin, TX 78701
FAX: 512-478-1426 |
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Resolution to Increase Optional Workers' Compensation Coverage (Sample) |
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Resolution to Add Optional Workers' Compensation Coverage (Sample) |
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Notice 5 Notice to Employees Concerning Workers' Compensation in Texas for employers who do not have coverage (Rev. 10/05) |
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Aviso 5S (Spanish) Aviso sobre Compensación para Trabajadores en Tejas (Rev. 2/06) |
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Notice 6 Notice to Employees Concerning Workers' Compensation in Texas for Employers who do have coverage (Rev. 10/05) |
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Aviso 6S (Spanish) Aviso sobre Compensación para Trabajadores en Tejas (Rev. 10/05) |
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Notice 8 Required Workers' Compensation Coverage (building or construction projects for governmental entities) (Rev. 10/05) |
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Aviso 8S (Spanish) Cobertura Requerida de Compensación para Trabajadores (Rev. 1/06) |
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Notice 9 Notice Regarding Certain Work-Related Communicable Diseases and Eligibility for Workers' Compensation Benefits (Rev. 10/05) |
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Aviso 9S (Spanish) Aviso Acerca de Ceirtas Enfermedades Contagiosas Relacionadas al Trabajo y Eligibilidad para Beneficios de Compensación para Trabajadores (Rev. 10/05) |
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DWC FORM-1 Employer's First Report of Injury or Illness (Rev. 10/05) |
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DWC FORM-156 Prospective Employment Authorization and Certification
(Rev. 10/05) |
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DWC FORM-2 Employer's Report for Reimbursement of Voluntary Payment Interim (Rev. 10/05) |
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DWC FORM-3 Employer's Wage Statement (Rev. 10/05) |
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DWC FORM-4 Employer's Contest of Compensability (Rev. 10/05) |
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DWC FORM-45 Request for a Benefit Review Conference (Rev. 10/05) |
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DWC FORM-5 Employer Notice of No Coverage or Termination of Coverage
(Rev. 10/05) |
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DWC FORM-53 Employee's Request to Change Treating Doctors (Rev. 10/05) |
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DWC FORM-6 Supplemental Report of Injury (Rev. 10/05) |
