SIF-5A Cover Sheet: Wage Calculations
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
SIF-5A Cover Sheet: Wage Calculations (A fillable form - 530 KB PDF)
 SIF-5A Cover Sheet: Wage Calculations (81 KB XLS)
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| Description | Used by only self-insured employers and their representatives to calculate and report injured workers’ wages and time loss compensation rates. |
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| Detail | ||
| Form number | F207-156-000 | |
| Availability | Online only. See document above to download. |
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| Keywords | calculations, injuries, injury, self insurance, self insurer, self-insurance, self-insurer, time-loss, time-loss compensation, worker's compensation, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 07-2009 , 04-2013 | |
| Contact information | ||
| Related information | ||
| Documents | Self-Insurance Report of Occupational Injury or Disease (SIF-5) |
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| Web pages | Insurance for Business Self-Insured Employers Checklists & Instructions for self-insurers |
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