August 19, 1998
SAMPLE INSURANCE CO
C/O SAMPLE INSURANCE CO
%W C DIVISION
204 E WASHINGTON #161
MADISON WI 53720
According to our records, you submitted an incomplete Wage Information Supplement, WKC-13-A. For us to determine the correct average weekly wage for computing the TTD rate, please answer the following questions and return this form to the Workers Compensation Division within 30 days.
How many hours per week was the employe scheduled when injured? ______
How many other employes worked the same schedule of hours per week? ______
How many full-time employes did the same type of work? ______
How many hours per week are full-time employes doing the same kind of work normally scheduled to work? ______
Thank you for your help in assuring correct compensation payments.
Failure to submit this required report within 30 days may result in a $100 forfeiture pursuant to sec. 102.35(1), Wis. Stats.