Wisconsin Worker s Compensation Advance Request Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your WC Claim Number and Employee Name in the designated fields. Ensure accuracy as this information is crucial for processing your request.
3. Provide your Social Security Number (optional) and Date of Injury. If you are not the employee, fill in the Requester Name and indicate if you are requesting as a Beneficiary due to a work-related fatality.
4. Complete your Address, Employment Status, Date of Birth, and Marital Status. If currently employed, include your Employer Name and Phone Number.
5. Detail your gross salary or wages along with any other present income sources. Specify the number of dependents under 18 years of age.
6. In the section for property owned, list all personal and real estate assets. Include any child support obligations and savings amounts.
7. Clearly state the amount requested for advancement and provide specific reasons along with current copies of bills that are overdue.
8. Finally, certify correctness by signing and dating the form before submitting it through our platform.

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