State of Nevada Forms in Word

Nevada Forms

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SHORT FORM DEED OF TRUST AND ASSIGNMENT OF RENTS $12.99

Nevada Workers Comp Forms

Form No. Form Title

Price

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C-3

Employer’s Report of Industrial Injury or Occupational Disease.

$27.99

C-4

Employee’s Claim for Compensation/Report of Initial Treatment.

$27.99

D-5

Wage Calculation Form for Claims Agent’s Use.

$27.99

D-6

Injured Employee’s Request for Compensation.

$27.99

D-7

Explanation of Wage Calculation.

$27.99

D-8

Employer’s Wage Verification Form.

$27.99

D-9(a)

Permanent Partial Disability Award Calculation Worksheet.

$27.99

&D-9(b)

Permanent Partial Disability Award Calculation Worksheet for Disability Over 25 Percent Body Basis.

$27.99

D-9(c)

Permanent Partial Disability Worksheet for Stress Claims Pursuant to NRS 616c.180.

$27.99

D-10(a)

Election of Method of Payment of Compensation.

$27.99

D-10(b)

Election of Method of Payment of Compensation for Disability Greater than 25 Percent.

$27.99

D-11

Reaffirmation/Retraction of Lump Sum Request.

$27.99

D-12(a)

Request for Hearing – Contested Claim.

$27.99

D-12(b)

Request for Hearing – Uninsured Employer.

$27.99

D-13

Injured Employee’s Right to Reopen a Claim Which Has Been Closed.

$27.99

D-14

Permanent Total Disability Report of Employment.

$27.99

D-15

Election for Nevada Workers’ Compensation Coverage for Out-of-State Injury.

$27.99

D-16

Notice of Election for Compensation Benefits Under the Uninsured Employer Statutes.

$27.99

D-17

Employee’s Claim for Compensation – Uninsured Employer.

$27.99

D-18

Assignment of Claim for Workers’ Compensation – Uninsured Employer.

$27.99

D-21

Fatality Report.

$27.99

D-22

Notice to Employees – Tip Information.

$27.99

D-23

Employee’s Declaration of Election to Report Tips.

$27.99

D-24

Request for Reimbursement of Expenses for Travel and Lost Wages.

$27.99

D-25

Affirmation of Compliance with Mandatory Industrial Insurance Requirements.

$27.99

D-26

Application for Reimbursement of Claim-Related Travel Expenses.

$27.99

D-27

Interest Calculation for Compensation Due.

$27.99

D-28

Rehabilitation Lump Sum Request.

$27.99

D-29

Lump Sum Rehabilitation Agreement.

$27.99

D-30

Notice of Claim Acceptance.

$27.99

D-31

Notice of Intention to Close Claim.

$27.99

D-32

Authorization Request for Additional Chiropractic Treatment.

$27.99

D-33

Authorization Request for Additional Physical Therapy Treatment.

$27.99

D-34

CMS 1500 Billing Form.

$27.99

D-35

Request for a Rotating Rating Physician or Chiropractor.

$27.99

D-36

Request for Additional Medical Information and Medical Release.

$27.99

D-37

Insurer’s Subsequent Injury Checklist.

$27.99

D-38

Injured Worker Index System Claims Registration Document.

$27.99

D-39

Physician’s Progress Report – Certification of Disability.

$27.99

D-43

Employee’s Election to Reject Coverage and Election to Waive the Rejection of Coverage for Excluded Persons.

$27.99

D-44

Election of Coverage by Employer; Employer Withdrawal of Election of Coverage.

$27.99

D-45

Sole Proprietor Coverage.

$27.99

D-46

Temporary Partial Disability Calculation Worksheet.

$27.99

D-48

Proof of Coverage Notice.

$27.99

D-49

Information Page.

$27.99

D-50

Policy Termination, Cancellation and Reinstatement Notice.

$27.99

D-52

Alternative Choice of Physician or Chiropractor.

$27.99

D-53

Special Note

$27.99

OD-1

Firemen and Police Officers’ Medical History Form.

$27.99

OD-2

Firemen and Police Officers’ Lung Examination Form.

$27.99

OD-3

Firemen and Police Officers’ Extensive Heart Examination Form.

$27.99

OD-4

Firemen and Police Officers’ Limited Heart Examination Form.

$27.99

OD-5

Firemen and Police Officers’ Hearing Examination Form.

$27.99

OD-6

Firemen and Police Officers’ Sample Letter.

$27.99

OD-7

Information Regarding Physical Examinations for Firemen and Police Officers.

$27.99

OD-8

Occupational Disease Claim Report

$27.99

C-4

Employee’s Claim for Compensation/Report of Initial Treatment;

$27.99

D-12(b)

Request for Hearing – Uninsured Employer;

$27.99

D-16

Notice of Election for Compensation Benefits Under the Uninsured Employer Statutes;

$27.99

D-17

Employee’s Claim for Compensation – Uninsured Employer

$27.99

D-18

Assignment of Claim for Workers’ Compensation – Uninsured Employer

$27.99