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TDI Form NumberDescriptionFile FormatLanguageDWC003Employer's wage statement. Rev. Providers for group practice enrollment. •.Refer to Addendum 3 to add additional license and certification information. Attach documentation as needed. For additional information, see the Online Public Meeting Notice. The Alaska Workers' Compensation Board will conduct a full board meeting on May 18-19, 2023. These benefits are the responsibility of the self-insured employer or the employer's worker's compensation insurance carrier. Benefits include medical treatment for work-related conditions and cash payments that partially replace lost wages. STEP 1: Complete an Application. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes