Joan K - wyomingworkforce 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Claim Number in the designated field, as this is a required entry.
3. Fill in the Date of Injury and your Name, ensuring all details are accurate for processing.
4. Provide your Phone Number and Physical Address. If you have a new address, check the corresponding box.
5. Complete the Mailing Address section if it differs from your Physical Address, including City, State, and Zip Code.
6. Certify the accuracy of your information by signing and dating the form at the bottom.
7. List any travel details under 'From City and/or Address' and 'To City and/or Address', ensuring you include all necessary locations.
8. Document any related expenses in the provided sections, including receipts for verification.
9. Review all entries for completeness before saving or exporting your filled form for submission.

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