The Iowa Division of Workers' Compensation (DWC) requires the use of agency forms for certain filings.
Failure to use the correct form may result in your filing being rejected.
This page contains links to help you find and use current DWC forms.
Adobe Acrobat
You must use Adobe Acrobat to complete DWC forms electronically. Other PDF readers might not render the forms correctly. To get Adobe Acrobat Reader for free, click here.
Before efiling, Lock or "Flatten" Completed PDF Form
Please lock or "flatten" the PDF document after completing the form fields to ensure the document can be viewed on all devices and to prevent other users from manipulating or editing the information.
Index
To view forms under a category, click on the corresponding link below:
- Search
- Pleadings
- Hearing
- Settlement
- Commutation
- Filing
- Information Requests to DWC
- EDI & Compliance
- Miscellaneous
Search
To search all DWC forms and publications, click here.
Pleadings
Arbitration
Form 100 — Original Notice & Petition
Independent Medical Examination (IME)
Form 100A — Original Notice & Petition Concerning Application for IME
Form 100A — Answer to Petition Concerning Application for IME
Vocational Rehabilitation Program Benefit Under Iowa Code Section 85.70(1)
Form 100B — Original Notice & Petition Concerning Vocational Rehabilitation Program Benefit
Form 100B — Answer Concerning Vocational Rehabilitation Program Benefit
Alternate Care
Form 100C — Original Notice & Petition Concerning Application for Alternate Care
Form 100C — Answer to Petition Concerning Application for Alternate Care
Vocational Training & Education Under Iowa Code Section 85.70(2)
Hearing
Hearing Report
Hearing Report — No Second Injury Fund
Hearing Report — Second Injury Fund
Shorthand Reporter Identification
Shorthand Reporter Identification
Settlement
Payment Activity Report (PAR) for Settlements
Commutation
Payment Activity Report (PAR) for Commutations
Filing
Application to Defer Payment of Filing Fees & Financial Affidavit
Information Requests to DWC
Authorization to the Iowa Division of Workers' Compensation to Release Information
EDI & Compliance
Payment Activity Report (PAR) for EDI & Compliance
Miscellaneous
Application for Payment of Benefits
Medical Report Transmittal Form
Dispute Resolution Conference Report
Authorization to Release Information Regarding Claimant Seeking Workers' Compensation Benefits