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Wkc 136 advancement or lump sum request form

Wkc 136 advancement or lump sum request form 2026

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The document is a request form from the Department of Workforce Development's Worker’s Compensation Division for employees seeking an advancement on their permanent disability benefits. It outlines the necessary personal and financial information required to process the request, explains the conditions under which advancements may be granted, and notes that decisions will typically be made within 10 days. The document also mentions that not all requests will be approved and specifies that certain types of debts are ineligible for advancement.

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Click ‘Get Form’ to open the wkc 136 advancement or lump sum request form in the editor.
Begin by entering your WC Claim Number, which is for office use only. Then, fill in your personal information including your name, Social Security Number, and address.
Provide details about your injury by entering the injury date and your telephone number. Indicate whether you are currently employed and provide your marital status.
Fill in your employer's information, including their name, phone number, and address. Next, state your gross salary or wages along with any other present income sources.
List the number of dependents under 18 years of age and any property owned. Include details about hours worked per week and spouse’s employment if applicable.
Clearly specify the amount requested for advancement along with a detailed reason for the request. Attach current copies of bills that are overdue.
Finally, certify the form by signing it and dating it before submitting it to the Worker’s Compensation Division at the provided address.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (67 Votes)
2001	4.3 Satisfied (70 Votes)

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