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Get a Form or Publication - Washington State Department of

Get a Form or Publication - Washington State Department of 2026

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The document is a Statement for Pharmacy Services that outlines the process for injured workers to seek reimbursement for prescription costs related to their worker's compensation claims. It includes instructions on completing the form, required information such as worker and pharmacy details, prescription specifics, and emphasizes the need for attaching receipts. The statement must be submitted within 12 months of service, and it certifies the accuracy of the provided prescription information.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Worker Information section. Enter your social security number, claim number, full name, mailing address, and employer's name clearly.
Next, move to the Pharmacy Information section. Provide the pharmacy's name and physical address, along with their L&I provider number or NPI.
In the Prescription Information section, complete all fields as required by entering details such as the date written, prescribing provider's name and number, prescription number, and drug information including quantity and total cost.
Finally, ensure you sign in the Injured Worker Signature section to certify that all information is accurate. Don’t forget to attach your receipts for reimbursement.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is eligible for the Washington state tax credit?

Eligibility - general Have a valid Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). Lived in Washington a minimum of 183 days (over half the year). Are at least 25 and under 65 years of age OR have a qualifying child. Filed a federal tax return the year before they claim the credit.

Does Washington state have a state tax form?

The state of Washington does not impose a personal income tax. To receive federal income tax forms, please visit the Internal Revenue Service (IRS) website(opens in a new window).

What is the $1200 check from the government?

Starting in March 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided Economic Impact Payments of up to $1,200 per adult for eligible individuals and $500 per qualifying child under age 17.

Are Washington state residents getting a stimulus check?

There are no new stimulus checks for Washington residents in 2025. Other than the three Economic Impact Payments that were issued during the coronavirus pandemic, Congress has no plans to issue a fourth round of stimulus payments.

What is the $1200 tax credit in Washington state?

Working Families Tax Credit (WFTC) Beginning February 1, 2025, the Washington State Working Families Tax Credit (also known as the Washington Family Tax Credit) will provide a Washington tax refund of up to $1,290 to eligible individuals and families.

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Where can I get paper forms for taxes?

Get the current filing years forms, instructions, and publications for free from the IRS. Download them from IRS.gov. Order online and have them delivered by U.S. mail. Order by phone at 1-800-TAX-FORM (1-800-829-3676)

What is the $1200 payment in Washington state?

Working Families Tax Credit will provide payments up to $1,200 to individuals and families who meet the requirements. Applications open on February 1, 2023 and are accepted through December 31, 2023.

How to order IRS tax forms and publications?

If you know what form or publication you need, call the IRS toll-free forms number at 1-800-TAX-FORM (1-800-829-3676).

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Who is eligible for the Washington state tax credit?

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Are Washington state residents getting a stimulus check?

What is the $1200 tax credit in Washington state?

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Get a Form or Publication - Washington State Department of 2026

Here's how it works

How to use or fill out Get a Form or Publication - Washington State Department of with our platform

See more Get a Form or Publication - Washington State Department of versions

Complete this form in 5 minutes or less

Got questions?

Who is eligible for the Washington state tax credit?

Does Washington state have a state tax form?

What is the $1200 check from the government?

Are Washington state residents getting a stimulus check?

What is the $1200 tax credit in Washington state?

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People also ask

Where can I get paper forms for taxes?

What is the $1200 payment in Washington state?

How to order IRS tax forms and publications?

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