FORM 22 Fillable 2025

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Apply the two-thirds rule: Calculate two-thirds of the comparable employees average weekly earnings to determine the workers comp wage benefit for the injured employee.
Form 22: Statement of Days Worked Earnings of Employee. This form requires an accounting of wages paid to the injured employee over the year prior to their injury. It is used to determine the compensation rate if there is a disagreement about earnings or if the Industrial Commission requests it.
Use VA Form 22-5490 when a spouse or dependent is applying for educational benefits under Chapter 35 Survivors and Dependents Education Assistance (DEA) or Chapter 33 Fry Scholarship.
How to fill out NC Form 22? To fill out NC Form 22, taxpayers must provide their personal information, input their income figures, claim any deductions or credits they are eligible for, and ensure all required fields are completed accurately.
Individuals who are sole proprietors, members of LLCs, and partners are not automatically counted as employees. Corporate officers may elect to be excluded from coverage but are still counted in determining whether a business has three or more employees.

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Use VA Form 21-22 when you want to have a Veterans Service Organization (VSO) help you with VA benefits or claims.
Claims Process Step 1: Tell Your Employer or Supervisor Immediately About Your Injury. Step 2: Get Medical Attention. Step 3: File a Written Accident Report With Your Employer. Step 4: Reporting the Injury to the NC Industrial Commission. Step 5: Follow All Doctors Orders.

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