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- Click ‘Get Form’ to open the wds 1 2014 form in the editor.
- Begin with Part A. Fill in your full name, birth date, and Social Security Number clearly. Ensure that your home address is complete.
- In Item 9, indicate your citizenship status. If you are not a U.S. citizen, provide your Alien Registration Number and country of origin.
- Complete Items 12-15 with exact dates related to your disability and any emergency room care received. Be thorough to avoid delays.
- For Part A1, designate a representative if needed and sign the authorization. Include your contact number for follow-up.
- Ensure Parts B and C are completed by your doctor and employer respectively before submitting all parts together via mail or fax.
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