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Rhode Island Form Center


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(dwc01) Employer's First Report of Alleged Occupational Injury or Disease - 1/03
(dwc02) Memorandum of Agreement - 1/03
(dwc03f) Wage Statement: Full Time - 1/03
(dwc03s) Wage Statement: Seasonal - 1/03
(dwc04) Employee's Certificate of Dependency Status - 1/03
(dwc05) Suspension Agreement and Receipt - 1/03
(dwc08) WC Act Summary Poster - 5/04
(dwc08-sp) WC Act Summary Poster (Spanish) - 5/04
(dwc09) Insurance Coverage Certification For Temporary Employment and Employee Leasing Companies - 11/05
(dwc11) Notice of Claim of Common Law Rights - 1/02
(dwc11-ic) Notice of Designation as an Independent Contractor - 3/06
(dwc11c) Election by Exempt Corporate Officer to Become Subject to Workers' Compensation - 11/06
(dwc11-icr) Notice of Withdrawal of Designation as Independent Contractor - 3/06
(dwc11r) Rescind Notice of Claim of Common Law Rights - 1/02
(dwc20) Non-Prejudicial Agreement - 1/03
(dwc22) Report of Indemnity Payment - 1/03
(dwc24) Mutual Agreement - 1/03
(dwc25) Report of Earnings - 1/03
(dwc27) Physician's Notice of Release to Work - 4/02
(dwc29) Notification of Claim of Compensable Injury - 4/02
(dwc30) Wage Transcript - 1/03
(dwc31) Employee's Objection to Wage Transcript - 1/03
(dwc32) Notice to Employees Regarding Benefit Check - 1/03
(dwc36) Coordination Of Retirement Benefits - 4/05
(dwc40) Request For Additional Palliative Care - 4/05
(dwc50) Itemized Statement of Compensation - 1/03
(dwc51) Report of Specific Payment - 1/03
(WCAFAsmtReturn2007) Workers Compensation Administrative Fund Information Request For Calendar Year 2007 - N/D