Forms

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
  • Form 100 — Original Notice & Petition
  • Independent Medical Examination (IME)
  • Vocational Rehabilitation Program Benefit Under Iowa Code Section 85.70(1)
  • Alternate Care
  • Vocational Training & Education Under Iowa Code Section 85.70(2)
• Hearing
• Settlement
• Commutation
• Filing
• Information Requests to DWC
• EDI & Compliance
• Miscellaneous

Search

To search all DWC forms and publications, click here.

Return to Index.

Pleadings

Arbitration

Form 100 — Original Notice & Petition

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Independent Medical Examination (IME)

Form 100A — Original Notice & Petition Concerning Application for IME

Form 100A — Answer to Petition Concerning Application for IME

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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

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Alternate Care

Form 100C — Original Notice & Petition Concerning Application for Alternate Care

Form 100C — Answer to Petition Concerning Application for Alternate Care

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Vocational Training & Education Under Iowa Code Section 85.70(2)

Form 100D — Original Notice & Petition Concerning  Application for Vocational Training & Education for Shoulder Injuries

Form 100D — Answer to Petition Concerning Application for Vocational Training & Education for Shoulder Injuries

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Hearing

Hearing Report

Hearing Report — No Second Injury Fund

Hearing Report — Second Injury Fund

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Shorthand Reporter Identification

Shorthand Reporter Identification

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Settlement

Agreement for Settlement

Compromise Settlement

Combination Settlement

Contingent Settlement

Claimant's Statement

Payment Activity Report (PAR) for Settlements

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Commutation

Full Commutation

Partial Commutation

Payment Activity Report (PAR) for Commutations

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Filing

Application to Defer Payment of Filing Fees & Financial Affidavit

Request for Waiver of the Mandatory Use of the Workers' Compensation Electronic System (WCES) to Electronically File (eFile) Documents

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Information Requests to DWC

Information Request

Authorization to the Iowa Division of Workers' Compensation to Release Information

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EDI & Compliance

First Report of Injury (FROI)

Payment Activity Report (PAR) for EDI & Compliance

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Miscellaneous

Application for Payment of Benefits

Medical Report Transmittal Form

Dispute Resolution Conference Report

Authorization to Release Information Regarding Claimant Seeking Workers' Compensation Benefits

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