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 (14-0007)
Form 100A — Answer to Petition Concerning Application for IME (14-0007A)
Vocational Rehabilitation Program Benefit Under Iowa Code Section 85.70(1)
Form 100B — Answer Concerning Vocational Rehabilitation Program Benefit (14-0009A)
Alternate Care
Form 100C — Original Notice & Petition Concerning Application for Alternate Care (14-0011)
Form 100C — Answer to Petition Concerning Application for Alternate Care (14-0011A)
Vocational Training & Education Under Iowa Code Section 85.70(2)
Hearing
Hearing Report
Hearing Report — No Second Injury Fund (14-0047)
Hearing Report — Second Injury Fund (14-0047)
Shorthand Reporter Identification
Shorthand Reporter Identification (14-0178)
Settlement
Agreement for Settlement (14-0021)
Compromise Settlement (14-0025)
Combination Settlement (14-0159)
Contingent Settlement (14-0161)
Claimant's Statement (14-0163)
Payment Activity Report (PAR) for Settlements (14-0147)
Commutation
Payment Activity Report (PAR) for Commutations (14-0147)
Filing
Application to Defer Payment of Filing Fees & Financial Affidavit (14-0075)
Application for eFiling Exception (14-0176)
Information Requests to DWC
Authorization to the Iowa Division of Workers' Compensation to Release Information (14-0196)
EDI & Compliance
First Report of Injury (FROI) (14-0001)
Payment Activity Report (PAR) for EDI & Compliance (14-0174)
Miscellaneous
Application for Payment of Benefits (14-0037)
Medical Report Transmittal Form (14-0141)