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Workers' Compensation Forms and Worksheets. Lost Form W2Reissued statement.Military differential pay. Please complete the MFS Dispute Request Form and forward directly to the Commission. The guides will help you fill out forms you may need to get a problem with your claim resolved at the local DWC district office. Medical Treatment Statement - For listing charges from medical providers, or for medicine and supplies. Application to Individually Self-Insure. Forms Numerical ; REPORTE MENSUAL DE GANANCIAS DEL EMPLEADO, This document is a PDF. Form NumberForm NameCategoryAO 10AFinancial Disclosure Report RequestOther FormsAO 30Certified CopyOther FormsAO 35Certificate of Official Court ReporterCourt Reporter Forms You must obtain the approval of the appropriate department financial administrator.