The Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24, 1996) is a document used in the state of Pennsylvania to report wages and other income earned by a worker who has been injured on the job. It is typically completed by the injured worker's employer and is used to determine the worker's compensation benefits. This document is also used to report income earned by a worker who has been injured off the job, provided the injury is related to the worker's employment. There are two types of this statement: the “Long Form” and the “Short Form.” The Long Form must be used when a worker has more than one employer, while the Short Form can be used when a worker has only one employer. The Long Form must also be used when the worker has any income from outside sources, such as investments or rental income, while the Short Form can be used when the worker has no other sources of income. Both forms must be signed and dated by the employer and must be submitted to the Pennsylvania Department of Labor and Industry in order to receive worker's compensation benefits.
The Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24, 1996) is a document used in the state of Pennsylvania to report wages and other income earned by a worker who has been injured on the job. It is typically completed by the injured worker's employer and is used to determine the worker's compensation benefits. This document is also used to report income earned by a worker who has been injured off the job, provided the injury is related to the worker's employment. There are two types of this statement: the “Long Form” and the “Short Form.” The Long Form must be used when a worker has more than one employer, while the Short Form can be used when a worker has only one employer. The Long Form must also be used when the worker has any income from outside sources, such as investments or rental income, while the Short Form can be used when the worker has no other sources of income. Both forms must be signed and dated by the employer and must be submitted to the Pennsylvania Department of Labor and Industry in order to receive worker's compensation benefits.
