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  2. Forms Repository
  3. WKC-6119-E, Social Security Reverse Offset Worksheet

Social Security Reverse Offset Worksheet

Document Number: WKC-6119-E

Description: This form is completed from the Social Security Administration Office information. It shows how Worker's Compensation arrived with the Social Security Offset. It is used internally by Worker's Compensation staff, and also by insurance companies and attorneys. Most of the time this form is sent to the insurance company from the Department of Workforce Development.

Comments: This form can be filled out on the computer as a fillable pdf.

Content Contact: Lynn Weinberger

Document Attachment: WKC-6119-E (Electronic Version - pdf/163 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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