Last updated: 5/21/2009
Temporary Partial Disability Calculation Worksheet {D-46}
Start Your Free Trial $ 13.99What you get:
- Instant access to fillable Microsoft Word or PDF forms.
- Minimize the risk of using outdated forms and eliminate rejected fillings.
- Largest forms database in the USA with more than 80,000 federal, state and agency forms.
- Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
- Trusted by 1,000s of Attorneys and Legal Professionals
Description
Temporary Partial Disability Calculation Worksheet (NAC 616C.598(7)) For Claims Agents Use Injured Employee Insurer Third-Party Administrator Employer Claim Number SSN Pay Period (From) / / Paid: Weekly Pay Period (To) / / Bi-Weekly Semi-Monthly Monthly Gross Wage $ SSTax/FICA $ Days Not Included in Pay Period Medicare $ Reason for Absence: FIT/FWT $ Other (define) $ Net Wage $ (after the usual deductions are made for social security, income taxes and other required state or federal deductions) Pursuant to NAC 616C.598(2). TTD $ (for the same period) Net Wage - $ TPD due $ (if the net pay is greater than the TTD rate, there is no entitlement to TPD) Pursuant to NAC 616C.598(1). Prepared By Date D-46 (7/99)
Related forms
-
Application For Reimbursement Of Claim Related Travel Expenses
Nevada/Workers Comp/ -
Assignment To Division For Workers Compensation Benefits
Nevada/Workers Comp/ -
Authorization Request For Additional Chiropractic Treatment
Nevada/Workers Comp/ -
Authorization Request For Additional Physical Therapy Treatment
Nevada/Workers Comp/ -
Election For Nevada Workers Compensation Coverage For Out Of State Injury
Nevada/Workers Comp/ -
Election Of Coverage By Employer And Employer Withdrawal Of Election Of Coverage
Nevada/Workers Comp/ -
Employees Claim For Compensation - Uninsured Employer
Nevada/Workers Comp/ -
Employees Declaration Of Election To Report Tips
Nevada/Workers Comp/ -
Employees Election To Reject Coverage And Election To Waive Rejection Of Coverage For Excluded Persons
Nevada/Workers Comp/ -
Fatality Report
Nevada/Workers Comp/ -
Health Insurance Claim Form
Nevada/Workers Comp/ -
Insurers Subsequent Injury Checklist
Nevada/Workers Comp/ -
Interest Calculation For Compensation Due
Nevada/Workers Comp/ -
Lump Sum Rehabilitation Agreement
Nevada/Workers Comp/ -
Notice Of Election For Compensation Benefits Under Uninsured Employer Statutes
Nevada/Workers Comp/ -
Notice Of Intention To Close Claim
Nevada/Workers Comp/ -
Permanent Total Disability Report Of Employment
Nevada/Workers Comp/ -
Rehabilitation Lump Sum Request
Nevada/Workers Comp/ -
Request For Hearing - Contested Claim
Nevada/Workers Comp/ -
Request For Hearing - Uninsured Employer
Nevada/Workers Comp/ -
Sole Proprietor Coverage
Nevada/Workers Comp/ -
Temporary Partial Disability Calculation Worksheet
Nevada/Workers Comp/ -
Wage Calculation Form For Claims Agents Use
Nevada/Workers Comp/ -
Policy Termination-Cancelation-Reinstatement Notice
Nevada/Workers Comp/ -
Proof Of Coverage Notice
Nevada/Workers Comp/ -
Request For Reimbursement Of Expenses For Travel And Lost Wages
Nevada/Workers Comp/ -
Complaint Form (Northern Inusurers)
Nevada/Workers Comp/ -
Complaint Form (Southern Insurers)
Nevada/Workers Comp/ -
Index Of Claims System Claim Registration
Nevada/Workers Comp/ -
Employers Report Of Industrial Injury Or Occupational Disease
Nevada/Workers Comp/ -
Notice Of Injury Or Occupational Disease Incident Report
Nevada/Workers Comp/ -
Reaffirmation Retraction Of Lump Sum Request
Nevada/Workers Comp/ -
Injured Employees Request For Compensation
Nevada/Workers Comp/ -
Firefighters And Police Officers Medical History
Nevada/Workers Comp/ -
Firefighters And Police Officers Lung Examination
Nevada/Workers Comp/ -
Firefighters And Police Officers Limited Heart Examination
Nevada/Workers Comp/ -
Firefighters And Police Officers Hearing Examination
Nevada/Workers Comp/ -
Occupational Disease Claim Report
Nevada/Workers Comp/ -
Permanent Partial Disability Award Calculation Work Sheet
Nevada/Workers Comp/ -
Permanent Partial Disability Award Calculation Work Sheet For Disability Over 30 Percent Body Basis
Nevada/Workers Comp/ -
Election Of Lump Sum Payment Of Compensation
Nevada/Workers Comp/ -
Election Of Lump Sum Payment Of Compensation For Disability Greater Than 30 Percent
Nevada/Workers Comp/ -
Firefighters And Police Officers Extensive Heart Examination
Nevada/Workers Comp/ -
Notice Of Claim Acceptance
Nevada/Workers Comp/ -
Employees Claim For Compensation Report Of Initial Treatment
Nevada/Workers Comp/ -
Employers Wage Verification Form
Nevada/Workers Comp/ -
Affirmation Of Compliance With Mandatory Industrial Insurance Requirements
Nevada/Workers Comp/ -
Request For Additional Medical Information And Release Form
Nevada/Workers Comp/ -
Physician And Chiropractor Progress Report Certification Of Disability
Nevada/Workers Comp/ -
Request For Rotating Rating Physician Or Chiropractor
Nevada/Workers Comp/ -
Informational Poster - Displayed By Employer
Nevada/Workers Comp/ -
Permanent Work Related Mental Impairment Rating Report Work Sheet
Nevada/Workers Comp/
Form Preview
Contact Us
Success: Your message was sent.
Thank you!