Wkc 13 printable form 2025

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The document is a Wage Information Supplement from the Wisconsin Department of Workforce Development, specifically for the Worker’s Compensation Division. It outlines the requirements for insurers and self-insured employers to report wage information related to temporary total disability (TTD) claims when the TTD rate is below the maximum for the year of injury. The form includes sections for reporting employee wages, hours worked, additional compensation, and specific instructions for part-time employees. It emphasizes the importance of accurate wage computation and timely submission within 30 days post-injury.

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Click ‘Get Form’ to open the WKC-13 printable form in the editor.
Begin by entering the 'Date of Injury' and the 'Employee Social Security Number'. Ensure that you provide accurate information as it is crucial for processing.
Fill in the 'Employee Name' and 'Employer Name', followed by the 'Name of Insurance Company or Self-Insured Employer'. This section is vital for identifying all parties involved.
Complete Section 1, starting with the 'Hourly Wage Multiply'. Enter the hourly rate at the time of injury and any additional compensation such as tips. Make sure to check if you need to include hours worked at time-and-a-half.
Proceed to Section 2, where you will calculate gross wages. Input the number of weeks worked and ensure all figures are accurate for a correct average weekly earnings calculation.
If applicable, complete Section 4 for part-time employees. This section helps determine wage calculations based on their work schedule.
Finally, review all entries for accuracy before saving or exporting your completed form. Utilize our platform's features to sign and share your document seamlessly.

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Versions	Form popularity	Fillable & printable
2022	4.9 Satisfied (28 Votes)
2009	4 Satisfied (45 Votes)

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