Social Security Reverse Offset Worksheet

Document Number:  WKC-6119

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 is not fill-enabled. It can be printed and completed by hand.

Content Contact:  Lynn Weinberger

Document Attachment:  WKC-6119 (pdf/125 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.

Email DWD DWD Photo Gallery DWD on Twitter DWD on Facebook DWD on YouTube DWD on LinkedIn DWD RSS Feed

A proud partner of the network