|
Form — Application for Payment of Benefits — 14-0037 |
Form -- Application for Payment of Benefits -- 14-0037 -- Nov. 2020.pdf |
|
Form — Application for eFiling Exception — 14-0176 |
Application for eFiling Exception -- Form 14-0176 -- July 2019.pdf |
|
Form — Agreement for Settlement — 14-0021 |
Agreement for Settlement -- Form 14-0021 -- 2019.07 empty.pdf |
|
Form 9A — Partial Commutation — 14-0017 |
Partial Commutation -- Original Notice & Petition -- Form 9A - 14-0017 --July 2019.pdf |
|
Form 9 — Full Commutation of All Remaining Benefits of 10 Weeks or More — 14-0013 |
Full Commutation -- Original Notice & Petition -- Form 9 - 14-0013 -- July 2019.pdf |
|
Form 100D — Original Notice & Petition — Vocational Training & Education for Shoulder Injuries — 14-0012 |
Form 100D -- Vocational Training & Education -- Original Notice & Petition --14-0012 -- Dec. 2019.pdf |
|
Form 100D — Answer — Vocational Training & Education — 14-0012A |
Form 100D -- Vocational Training & Education -- Answer -- 14-0012A.pdf |
|
Form 100C — Original Notice & Petition — Alternate Care — 14-0011 |
Alternate Care -- Original Notice & Petition -- Form 100C - 14-0011 -- July 2019.pdf |
|
Form 100C — Answer — Alternate Care — 14-0011A |
Alternate Care -- Answer -- Form 100C - 14-0011A -- July 2019.pdf |
|
Form 100B — Original Notice & Petition — Vocational Rehabilitation Program Benefit — 14-0009 |
Vocational Rehabilitation Program Benefit -- Form 100B - 14-0009 -- July 2019.pdf |
|
Form 100B — Answer — Vocational Rehabilitation Program Benefit — 14-0009A |
Vocational Rehabilitation Program Benefit -- Answer -- Form 100B - 14-0009A -- July 2019.pdf |
|
Form 100A — Original Notice & Petition — Independent Medical Examination — 14-0007 |
Independent Medical Exam -- Original Notice & Petition -- Form 100A - 14-0007 -- July 2019.pdf |
|
Form 100A — Answer — Independent Medical Examination (IME) — 14-0007A |
Form -- Independent Medical Examination -- Answer -- July 2019.docx_.pdf |
|
Form 100 — Original Notice and Petition — 14-0005 |
14-0005 form100fillable.pdf |
|
First Report of Injury or Illness 14-0001 |
First Report of Injury 14-0001 May 2015.pdf |
|
Fee Schedule for Information Requests |
Fee Schedule for Information Requests.pdf |
|
Event Table |
Release 2 Iowa Event Table.pdf |
|
Element Requirements Table |
R3elementrequirementtable (1).xls |
|
Element Requirements |
Release 2 Element Requirements Table.pdf |
|
Edit Matrix |
Release 2 Edit Matrix.pdf |
|
EDI Release 3 Event Table |
R3eventtable.xls |
|
EDI Release 3 Element Requirements |
R3elementrequirementtable (1).xls |
|
EDI Annual Reporting Requirement Activated |
edicannualreportingrequirement.pdf |
|
EDI Annual Reporting Requirement |
edicannualreportingrequirement.pdf |
|
EDI Amendment Letter |
EDI Amendment.pdf |
