Nc form 28c 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Employer FEIN and the Employee’s Name in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the Employer's Name and Address, including City, State, and Zip Code. This helps identify the employer associated with the claim.
4. Provide details about the accident or disability date in section 1. This is essential for establishing the timeline of events.
5. Indicate whether salary was continued during the employee's absence in section 2. This affects compensation calculations.
6. Complete sections 3 through 7 by detailing temporary total, partial, and permanent partial weeks along with corresponding dollar amounts.
7. In section 8, sum up all amounts from lines 3 through 7 to provide a total compensation figure.
8. 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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