|
855-1132
|
BWC/ BWCRKAD/ BWCRKADRTBC
|
RTBC/RRMF
|
Retrospective Rating Master File / UB 230
|
|
|
02/16/2010
|
|
|
855-1133
|
BWC/ BWCRKAD/ BWCRKADRTBC
|
RTBC/RRPM
|
Retrospective Rating Program Material and Application Information
|
|
|
04/05/2012
|
|
|
855-1134
|
BWC/ BWCBWCA/ BWCBWCABWCA
|
BOD-1
|
BWC Board of Directors Correspondence
|
|
|
03/09/2010
|
|
|
855-1135
|
BWC/ BWCALLS/ BWCALLSALLS
|
ALLS-32
|
Employer Visits (ETA)
|
|
|
04/29/2010
|
|
|
855-1136
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-165
|
Adjudicating Committee Hearing Records
|
|
|
12/17/2015
|
|
|
855-1137
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-160
|
Adjudicating Committee and Administrator’s Designee’s Internal Correspondence
|
|
|
01/20/2011
|
|
|
855-1138
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-170
|
Adjudication Committee Hearing Packets
|
|
|
08/11/2023
|
|
|
855-1139
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Subro/Frau
|
Subrogation Form Letters
|
|
|
10/11/2023
|
|
|
855-1140
|
BWC/ BWCRKAD/ BWCRKADRTUN
|
RTUN/AATS
|
Adjudication Assignment Tracking Schedule
|
|
|
02/05/2011
|
|
|
855-1141
|
BWC/ BWCALLS/ BWCALLSALLS
|
ALLS - 33
|
Physician Verification Slip
|
|
|
03/27/2013
|
|
|
855-1142
|
BWC/ BWCHUMA/ BWCHUMA
|
ESHA/SDS
|
Safety Data Sheet (SDS) for product chemical content
|
|
|
04/20/2017
|
|
|
855-1143
|
BWC/ BWCALLS/ BWCALLSALLS
|
MIAD-66
|
Confidential Personal Information (CPI) System Access Logs
|
|
|
03/10/2011
|
|
|
855-1146
|
BWC/ BWCHUMA/ BWCHUMALABO
|
HUMA/FMLA
|
Employee FMLA and related correspondence
|
|
|
03/28/2012
|
|
|
855-1147
|
BWC/ BWCSERA/ BWCSERACLMS
|
SERA/ALL
|
BWC / ODJFS Compensation Comparison Report
|
|
|
04/05/2012
|
|
|
855-1148
|
BWC/ BWCALLS/ BWCALLSALLS
|
ALLS-23
|
Flextime Forms
|
|
|
05/24/2012
|
|
|
855-1149
|
BWC/ BWCALLS/ BWCALLSALLS
|
ALLS-64
|
Analytical Trending and Forecasting Reports
|
|
|
05/24/2012
|
|
|
855-1150
|
BWC/ BWCFDAD/ BWCFDADARCO
|
ARCO - 64
|
Employer Policy Account Refunds
|
|
|
09/10/2018
|
|
|
855-1151
|
BWC/ BWCFDAD/ BWCFDADBUDG
|
Budget 49
|
Agency Budget Month End Reports
|
|
|
08/11/2017
|
|
|
855-1152
|
BWC/ BWCRISK/ BWCRISKRTBC
|
EMPC/PDPA
|
UA-5 Premium Discount Program (PDP) Application
|
|
|
03/01/2013
|
|
|
855-1153
|
BWC/ BWCRKAD/ BWCRKADRTBC
|
RKAD/PEO
|
Professional Employer Organization (PEO) File
|
|
|
04/23/2013
|
|