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Nc form 28c 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Employer FEIN and the Employee’s Name in the designated fields. Ensure accuracy as this information is crucial for processing.
- Fill in the Employer's Name and Address, including City, State, and Zip Code. This helps identify the employer associated with the claim.
- Provide details about the accident or disability date in section 1. This is essential for establishing the timeline of events.
- Indicate whether salary was continued during the employee's absence in section 2. This affects compensation calculations.
- Complete sections 3 through 7 by detailing temporary total, partial, and permanent partial weeks along with corresponding dollar amounts.
- In section 8, sum up all amounts from lines 3 through 7 to provide a total compensation figure.
- Finally, fill out your name, title, and signature at the bottom of the form before submitting it electronically via the provided portal link.
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