SIF-5A Cover Sheet: Wage Calculations

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Title SIF-5A Cover Sheet: Wage Calculations

Used by only self-insured employers and their representatives to calculate and report injured workers’ wages and time loss compensation rates.

Document number F207-156-000
How to get this document
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Valid dates 10/2013
Contact information Self-Insurance
Related information

Self-Insurance Report of Occupational Injury or Disease (SIF-5)

Websites Checklists & Instructions for self-insurers , Insurance for Business , Self-Insured Employers

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