Rhode island wage 2026

1. Click ‘Get Form’ to open the Rhode Island Wage Statement in the editor.
2. Begin by filling out the EMPLOYEE INFORMATION section. Enter your Social Security Number, select your gender, and provide your name, address, city, state, zip code, phone number, date of birth, and hired hours per week.
3. In the CLAIM INFORMATION section, input details about your employer and insurance company. Include the injury date and incapacity date as well as the maximum number of exemptions.
4. If employed for less than two weeks, indicate whether you agreed on an hourly wage. If not, provide the average weekly wage for similar employment.
5. For those employed for two weeks or longer, list gross wages prior to incapacity date over 13 consecutive weeks. Ensure to exclude overtime and bonuses from this calculation.
6. Complete the BONUS and OVERTIME sections by calculating total amounts paid in the past 52 weeks divided by weeks employed.
7. Finally, certify that you have followed all provisions by signing and dating where indicated.

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