State of Texas Forms in Word

Form No.

Title

 Price Buy Now

SPCB/T-4

TEXAS OFFICIAL WOOD DESTROYING INSECT REPORT

 $12.99
UCC 1 form

The UCC Financing Statement (Form UCC1)

 $12.99
UCC 1AD form

UCC Financing Statement Addendum (Form UCC1Ad)

 $12.99
UCC 1AP form

UCC Financing Statement Additional Party (Form UCC1AP)

 $12.99
UCC 3 form

The UCC Financing Statement Amendment (Form UCC3)

 $12.99
UCC 3AD form

National UCC Financing Statement Amendment Addendum (Form UCC3Ad)

 $12.99
UCC 3AP form

UCC Financing Statement Amendment Additional Party (Form UCC3AP)

 $12.99
Form UCC5

The Correction Statement (Form UCC5)

 $12.99
Form UCC11

The Information Request (Form UCC11) (Texas) (Rev. 05/09/01)

 $12.99
Texas 130-U Form   $12.99
HTF Program HTF Program Deed of Trust Texas $12.99
TCEQ 0230 Texas TCEQ 0130-EXP $12.99
Texas W-2 Form Oil Well Potential Test, Completion or Recompletion Report and Log $40.00
Texas DWC007 Employer’s Report of Non-covered Employee’s Occupational Injury or Disease& $27.99
Texas Form 2985 AFFIDAVIT FOR APPLICANTS FOR EMPLOYMENT WITH A LICENSED OPERATION OR REGISTERED CHILD-CARE HOME $12.99
EA/CF 1212S Blue Cross/Blue Shield ENROLLMENTAPPLICATION/CHANGEFORM $77.99

Texas Workers’ Compensation (DWC)Forms in Word

TDI Form Number Description (includes link to free govt. pdfs) Price Buy Now
TEXAS FORM DWC001 Employer’s First Report of Injury or Illness. This form is submitted to by carrier to TEXAS FORM DWC (with cover sheet and instructions) $29.00
TEXAS FORM DWC001S Employer’s First Report of Injury or Illness (for state employees) $29.00
TEXAS FORM DWC002 Employer’s Report for Reimbursement of Voluntary Payment $29.00
TEXAS FORM DWC003 Employer’s Wage Statement $29.00
TEXAS FORM DWC003ME Employee’s Multiple Employment Wage Statement $29.00
TEXAS FORM DWC003MES Declaración de Salario de Múltiples Trabajos del Empleado $29.00
TEXAS FORM DWC003S Declaración de Salario del Empleador $29.00
TEXAS FORM DWC003SD Employer’s Wage Statement for School Districts $29.00
TEXAS FORM DWC003SDS Declaración de Salario Para Escuelas de Distrito $29.00
TEXAS FORM DWC004 Employer’s Contest of Compensability $29.00
TEXAS FORM DWC005 Employer Notice of No Coverage or Termination of Coverage File Online File Online
TEXAS FORM DWC005s Notificación del Empleador por No Cobertura o Anulación de la Cobertura $29.00
TEXAS FORM DWC006 Supplemental Report of Injury $29.00
TEXAS FORM DWC007 Employer’s Report of Non-covered Employee’s Occupational Injury or Disease $29.00
TEXAS FORM DWC008 Return-to-Work Reimbursement Program for Employers $29.00
TEXAS FORM DWC008 Return-to-Work Reimbursement Program for Employers $29.00
TEXAS FORM DWC020 Insurance Carrier’s Notice of Coverage/Cancellation/Non-Renewal of Coverage $29.00
TEXAS FORM DWC020A Correction/Revision/Endorsement to Existing Policy $29.00
TEXAS FORM DWC020SI Self-Insured Governmental Entity Coverage Information $29.00
TEXAS FORM DWC022 Required Medical Examination (RME) – Request for Agreement / Request for Order $29.00
TEXAS FORM DWC022S Examen Médico Requerido (Required Medical Examination &RME, por su nombre y siglas en inglés) & Solicitud para un Acuerdo / Solicitud para una Orden $29.00
TEXAS FORM DWC024 Benefit Dispute Agreement $29.00
TEXAS FORM DWC024s Acuerdo para Disputa de Beneficios $29.00
TEXAS FORM DWC025 Benefit Dispute Settlement $29.00
TEXAS FORM DWC025s Acuerdo por Disputa de Beneficios $29.00
TEXAS FORM DWC026 Request for Reimbursement of Payment Made by Health Care Insurer $29.00
TEXAS FORM DWC027 Designation of Insurance Carrier’s Austin Representative $29.00
TEXAS FORM DWC030 Austin Representative’s Authorized Designees $29.00
TEXAS FORM DWC031 Application for Division Approval of Change in the Payment Period and/or Purchase of an Annuity for Death Benefits $29.00
TEXAS FORM DWC031s Solicitud para Obtener Aprobación por Parte de la División para un Cambio en el Periodo de Pago y/o Compra de una Pensión Para los Beneficios por Causa de Muerte $29.00
TEXAS FORM DWC032 Request for Designated Doctor Examination $29.00
TEXAS FORM DWC032S Solicitud para Obtener un Examen por Parte de un Médico Designado $29.00
TEXAS FORM DWC033 Carrier’s Request for Reduction of Income Benefits Due to Contribution $29.00
TEXAS FORM DWC035 Application for Division Approval of the Purchase of an Annuity for Lifetime Income Benefits $29.00
TEXAS FORM DWC041 Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease $29.00
TEXAS FORM DWC041 Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease $29.00
TEXAS FORM DWC041S Reclamo del Empleado para Compensación por una Lesión Relacionada con el Trabajo o Enfermedad Ocupacional $29.00
TEXAS FORM DWC041S Reclamo del Empleado para Compensación por una Lesión Relacionada con el Trabajo o Enfermedad Ocupacional $29.00
TEXAS FORM DWC042 Beneficiary Claim for Death Benefits $29.00
TEXAS FORM DWC042 Beneficiary Claim for Death Benefits $29.00
TEXAS FORM DWC042S Reclamación del Beneficiario para Obtener Beneficios por Causa de Muerte $29.00
TEXAS FORM DWC042S Reclamación del Beneficiario para Obtener Beneficios por Causa de Muerte $29.00
TEXAS FORM DWC044 Election to Engage in Arbitration $29.00
TEXAS FORM DWC044S Elección para Participar en un Arbitraje $29.00
TEXAS FORM DWC045 Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC) $29.00
TEXAS FORM DWC045A Request for a Medical Contested Case or SOAH Hearing $29.00
TEXAS FORM DWC045AS Solicitud para una Audiencia para Disputar Beneficios Médicos o Audiencia en la Oficina Estatal de Audiencias Administrativas (SOAH, por sus Siglas en Inglés) $29.00
TEXAS FORM DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (BRC-MFD) $29.00
TEXAS FORM DWC045MS Solicitud para Programar, Reprogramar, o Cancelar una Conferencia para Revisión de Beneficios para Apelar la Decisión de una Disputa por Honorarios Médicos (Benefit Review Conference to Appeal a Medical Fee Dispute Decision &BRC-MFD, por su nombre y siglas en inglés) $29.00
TEXAS FORM DWC045S Solicitud para Programar, Reprogramar, o Cancelar una Conferencia para Revisión de Beneficios (Benefit Review Conference -BRC, por su nombre y siglas en inglés) $29.00
TEXAS FORM DWC046 Employee’s Request for Acceleration of Impairment Income Benefits $29.00
TEXAS FORM DWC046S Solicitud del Trabajador Lesionado para Recibir un Pago Acelerado de Beneficios por Causa del Impedimento Corporal $29.00
TEXAS FORM DWC047 Employee’s Request for Advance of Benefits $29.00
TEXAS FORM DWC047S Solicitud del Empleado para Obtener Beneficios por Adelantado $29.00
TEXAS FORM DWC048 Request for Travel Reimbursement / Solicitud de Reembolso $29.00
TEXAS FORM DWC049 Request to Schedule a Medical Contested Case Hearing (MCCH) $29.00
TEXAS FORM DWC049S Solicitud para Programar una Audiencia para Disputar Beneficios Médicos (Medical Contested Case Hearing &MCCH, por su nombre y siglas en inglés) $29.00
TEXAS FORM DWC051 Employee’s Election for Commuted (Lump Sum) Impairment Income Benefits $29.00
TEXAS FORM DWC051S Elección del Empleado para la Conversión de los Beneficios de Ingresos de Impedimento a un Pago Total $29.00
TEXAS FORM DWC052 Application for Supplemental Income Benefits $29.00
TEXAS FORM DWC052S Aplicación del trabajador para beneficios de ingresos suplementales $29.00
TEXAS FORM DWC053 Employee Request to Change Treating Doctor $29.00
TEXAS FORM DWC053S Solicitud del Empleado para Cambiar de Médico de Tratamiento $29.00
TEXAS FORM DWC054 Notice to Employee: Intention to Request Division Permission to Adjust Benefits $29.00
TEXAS FORM DWC054S Aviso al/a la Empleado/a: Intencion de Solicitar permiso a la División para Ajuste de Beneficios $29.00
TEXAS FORM DWC055 Request to Adjust Average Weekly Wage for Seasonal Employee $29.00
TEXAS FORM DWC055S Solicitud de Ajuste al Salario Medio Semanal de un(a) Empleado/a de Temporada $29.00
TEXAS FORM DWC056 Carrier’s Request for Seasonal Employee Wage Information from Texas Workforce Commission Records $29.00
TEXAS FORM DWC057 Request for Extension of Maximum Medical Improvement Date for Spinal Surgery, for use on or after February 1, 2013 $29.00
TEXAS FORM DWC057S Solicitud para Extensión de la Fecha para el Mejoramiento Máximo Médico (Maximum Medical Improvement -MMI, por su nombre y siglas en inglés) por una Cirugía de la Columna Vertebral, para ser usado en o después del 1º de febrero de 2013 $29.00
TEXAS FORM DWC058 Request for Interlocutory Order $29.00
TEXAS FORM DWC060 Medical Fee Dispute Resolution Request $29.00
TEXAS FORM DWC060S Solicitud para Resolución de Disputas por Honorarios Médicos $29.00
TEXAS FORM DWC064 Medical Interlocutory Order Request – Continued Use of a Drug Previously Prescribed and Dispensed and Excluded from TDI-TEXAS FORM DWC’s Closed Formulary $29.00
TEXAS FORM DWC065 Application for Inclusion on Registry of Private Providers of Vocational Rehabilitation Services $29.00
TEXAS FORM DWC066 Statement of Pharmacy Services $29.00
TEXAS FORM DWC067 Designated Doctor Certification Application $29.00
TEXAS FORM DWC068 Designated Doctor Examination Data Report $29.00
TEXAS FORM DWC069 Report of Medical EvaluationSample Notice for Health Care Provider&(PDF, Word) N/A N/A
TEXAS FORM DWC070 Instructions For Completing The ADA J515 Dental Claim Form For Texas Workers’ Compensation Claims $29.00
TEXAS FORM DWC072 Medical Quality Review Panel Application $29.00
TEXAS FORM DWC073 Work Status Report $29.00
TEXAS FORM DWC074 Description of Injured Employee’s Employment $29.00
TEXAS FORM DWC081 Agreement Between General Contractor and Sub-Contractor to Provide Worker’s Compensation Insurance $29.00
TEXAS FORM DWC081S Acuerdo Entre el Contratista General y el Sub Contratista $29.00
TEXAS FORM DWC082 Agreement for Motor Carriers and Owner Operators $29.00
TEXAS FORM DWC083 Agreement for Certain Building and Construction Workers $29.00
TEXAS FORM DWC083S Acuerdo para Ciertos Trabajadores de Edificación y Construcción $29.00
TEXAS FORM DWC084 Exception to Application of Joint Agreement for Certain Building and Construction Workers $29.00
TEXAS FORM DWC085 Agreement Between General Contractor and Subcontractor to Establish Independent Relationship $29.00
TEXAS FORM DWC085S Acuerdo Entre el Contratista General y el Sub Contratista Para Establecer una Relación Independiente $29.00
TEXAS FORM DWC101 Program Review Report $29.00
TEXAS FORM DWC101 Program Review Report $29.00
TEXAS FORM DWC102 Accident Prevention Plan Cover Sheet $29.00
TEXAS FORM DWC102 Accident Prevention Plan Cover Sheet $29.00
TEXAS FORM DWC103 Approved Professional Source Safety Consultant Application– Note: The Approved Professional Source designation applies only to Loss Control Representatives of Texas Mutual Insurance Company as of September 1, 2005. $29.00
TEXAS FORM DWC104 Employer Request for TEXAS FORM DWC Safety Consultation $29.00
TEXAS FORM DWC104 Employer Request for TEXAS FORM DWC Safety Consultation $29.00
TEXAS FORM DWC105 Accident Prevention Services Worksheetfor use before 10/1/13 $29.00
TEXAS FORM DWC105 Accident Prevention Services WorksheetRev. 10/13 (for use on or after 10/1/2013) $29.00
TEXAS FORM DWC109 Accident Prevention Services Annual ReportRev. 12/05 $29.00
TEXAS FORM DWC109 Accident Prevention Services Annual ReportRev. 10/13 (for use on or after 10/1/2013) $29.00
TEXAS FORM DWC150 Notice of Representation or Withdrawal of Representation $29.00
TEXAS FORM DWC151 Attorney Application for Web Access $29.00
TEXAS FORM DWC152 Application for Attorney’s Fees $29.00
TEXAS FORM DWC153 Request for Copies of Confidential Claimant Information&- Effective September 1, 2006, requests for a claim file, medical dispute resolution file, and/or an indemnity resolution file must be made on the newly revised TEXAS FORM DWC-153 form (10/2006). A requestor must be eligible by statute to receive the $29.00
TEXAS FORM DWC153s Solicitud para Obtener Copias de la Información Confidencial del Reclamante $29.00
TEXAS FORM DWC155 Request for Record Check $29.00
TEXAS FORM DWC156 Prospective Employment Authorization and Certification $29.00
TEXAS FORM DWC156S Certificación Y Autorización De Un Posible Empleo $29.00
TEXAS FORM DWC205 Locations of Employer’s Business(es)Addendum to TEXAS FORM DWC Form-005 or TEXAS FORM DWC Form-020 $29.00
TEXAS FORM DWC205S Locaciones del Negocio(s) del EmpleadorSuplemento para el Formulario TEXAS FORM DWC005 o Formulario TEXAS FORM DWC020 $29.00
TEXAS FORM DWC210 Surety Bond for Certified Self-Insurance Liabilities $29.00
TEXAS FORM DWC210 Surety Bond for Certified Self-Insurance Liabilities $29.00
TEXAS FORM DWC215 Surety Bond Amount Rider $29.00
TEXAS FORM DWC215 Surety Bond Amount Rider $29.00
TEXAS FORM DWC216 Surety Bond Name Change Rider $29.00
TEXAS FORM DWC216 Surety Bond Name Change Rider $29.00
TEXAS FORM DWC223 Documentary Irrevocable Standby Letter of Credit $29.00
TEXAS FORM DWC223 Documentary Irrevocable Standby Letter of Credit $29.00
TEXAS FORM DWC224 Documentary Irrevocable Standby Letter of Credit (Confirmation) $29.00
TEXAS FORM DWC224 Documentary Irrevocable Standby Letter of Credit (Confirmation) $29.00
TEXAS FORM DWC225 Self-Insurer’s Agreement to Post Documentary Irrevocable Standby Letter of Credit $29.00
TEXAS FORM DWC225 Self-Insurer’s Agreement to Post Documentary Irrevocable Standby Letter of Credit $29.00
TEXAS FORM DWC226 Parental Guaranty $29.00
TEXAS FORM DWC226 Parental Guaranty $29.00
TEXAS FORM DWC227 Parental Guaranty for Less than Wholly Owned Subsidiary $29.00
TEXAS FORM DWC227 Parental Guaranty for Less than Wholly Owned Subsidiary $29.00
TEXAS FORM DWC228 Power of Attorney $29.00
T EXAS FORM DWC228 Power of Attorney $29.00
EDI-01 EDI TRADING PARTNER PROFILERev. 12/07 $29.00
EDI-02 Insurance Carrier or Trading Partner Medical Electronic Data Interchange (EDI) Profile $29.00
EDI-03 Medical EDI Compliance Coordinator and Trading Partner Notification $29.00
LHL009 Request for Review by an IROForm used by Patients/Injured Employees or persons acting on their behalf or health care providers to request a review by an Independent Review Organization (IRO) for disputes of medical necessity $29.00
LHL009 Request for Review by an IROForm used by Patients/Injured Employees or persons acting on their behalf or health care providers to request a review by an Independent Review Organization (IRO) for disputes of medical necessity $29.00