Application For Transitional Work Grant Program {BWC-3100}

BWC-3100 - APPLICATION FOR TRANSITIONAL WORK GRANT PROGRAM. This form is provided by the Ohio Bureau of Workers' Compensation. Employers seeking a grant for transitional work must complete the form with their business details, policy number, number of employees, and contact information. Employers applying for a grant must have: • Active coverage and current with monies owed to BWC. • No accumulative lapses in coverage in excess of 40 days within the 12 months preceding the application date. • Reported payroll and paid premium for the proceeding policy year. Employers are eligible for a Transitional Work Grant every five years. Your reimbursement is determined by BWC based on your company size. Maximum allowed per employer size are as follows: • 11 to 49 employees up to $3,700. • 50 to 199 employees up to $6,800. • 200 or more employees up to $8,200. BWC will assist those employers in development of a plan with fewer than 11 employees. www.FormsWorkflow.com