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Dwc program 2026
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- Click ‘Get Form’ to open the DWC Form-052 in the editor.
- Begin with Section 1: Employee Information. Fill in your name, Social Security Number, telephone number, date of injury, mailing address, and current treating doctor's details.
- Proceed to Section 2: Employer/Insurance Carrier Information. Enter your employer's name, insurance carrier's name, adjuster's name, and their contact number.
- In Section 3: SIBs Qualifying Information, provide your impairment rating, date of maximum medical improvement, quarter number, filing deadline, and qualifying period dates.
- Complete Section 4: Work Search Activities by documenting your job search efforts for each week of the qualifying period using the provided log.
- Fill out Section 5: Wages During Qualifying Period by entering gross wages earned for each week.
- Review and sign Section 6: Certification to confirm that all information is accurate before submitting your application.
Start filling out your DWC Form-052 today for free using our platform!
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2009 | 4.9 Satisfied (404 Votes) |
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