Temporary Partial Disability Calculation Worksheet {D-46} | Pdf Fpdf Doc Docx | Nevada

 Nevada   Workers Comp 
Temporary Partial Disability Calculation Worksheet {D-46} | Pdf Fpdf Doc Docx | Nevada

Last updated: 5/21/2009

Temporary Partial Disability Calculation Worksheet {D-46}

Start Your Free Trial $ 13.99
200 Ratings
What 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  • Minimize the risk of using outdated forms and eliminate rejected fillings.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

Our Products