www.iowaworkforce.org  

Division of 
Workers'
Compensation

 


Forms and Publications

Publications

Order Form For Books
(PDF 21.94 KB)
Iowa Workers’ Compensation Manual (Rate Book)
Iowa Workers’ Compensation Laws

2014-2015 Questions and Answers Brochure

2014-2015 Iowa Workers' Compensation Manuel
                  rate table (xlsx); Manual (pdf), Interest table

2013-2014 Questions and Answers Brochure

2013-2014 Iowa Workers' Compensation Manual
Rate Table (xlsx), Manual (pdf), interest table

2012-13 Iowa Workers' Compensation Manual
 Manual; Rate Table (xlsx) Manual, interest table - pdf (40 KB)

2012-2013 Question and Answer Brochure

2011-12 Iowa Workers' Compensation Manual
Rate Table (xls), Manual PDF (2MB), Interest Table-pdf (40KB)

2011-12 Question and Answer Brochure
90 kb

2010 Iowa Workers' Compensation Manual
RATE Table (.xlsx) - office 2007 version. Manual PDF PDF Interest Table (40KB)

2010 Question and Answer Brochure
90 KB

2009 Question and Answer Brochure
85.35 KB

2009 Iowa Workers' Compensation Manual
Excel Version (880 KB)  PDF Version (2 MB)
PDF Interest Table (40KB)

2008 Question and Answer Brochure
94 KB

2008 Iowa Workers' Compensation Manual
Excel Version (1.3 MB)   PDF Version (478.25KB)
PDF Interest Table - 40 KB

2007 Question and Answer Brochure
(97 KB)

2007 Iowa Workers' Compensation Manual
Excel (1569 KB)                 PDF (3.11 MB)

(PDF Interest Table - 40 KB)

2006 Iowa Workers' Compensation Manual
(PDF 4.6 MB)         (Excel  673KB)

(PDF Interest Table - 40 KB)

2006 Question and Answer Brochure
(PDF 99 KB)

2005 Iowa Workers' Compensation Manual
(PDF  4.58 MB)   (Excel 713 KB)
(PDF Interest Table - 40 KB)

2004 Iowa Workers' Compensation Manual
(PDF 397 KB)  (Excel 659 KB)

2003 Iowa Workers' Compensation Manual
(PDF 549  KB), (Excel 683.5  KB)

2002 Iowa Workers' Compensation Manual
(PDF 267 KB), (Excel 596 KB)

2001 Iowa Workers' Compensation Manual
(PDF 280 KB)
(Excel 650 KB), (Word 857 KB)

2000 Iowa Workers' Compensation Manual
(PDF 343 KB)

1999 Iowa Workers' Compensation Manual
(PDF 300 KB)


Forms

Employers First Report of Injury (FROI)   (rev'd 12-98)
(PDF 169 KB)   (IAIABC form 1.2) Form now fillable. 

Iowa FROI Instructions
(rev'd 7-98)

Medical Transmittal Form  (rev'd 3-00)
(PDF 35 KB)

Corporate Officer Exclusion  (rev'd 6-03)
(PDF 63 KB)

Dispute Resolution Conference Worksheet (rev'd 08/02)
(PDF  6.4 KB)

Claimant's Confidential Information Form (rev'd 7/12)
(PDF 47 KB)  must be filed with every original notice and petition.

Form 100 - Original Notice and Petition (rev'd 7-09)
(PDF 28 KB)  Form now fillable. 

Form 100A - 85.39 Petition for Independent Medical Examination (rev'd 1-09) (PDF 45 KB)  Form now fillable.

Form 100B - 85.70 Petition for Vocational Rehabilitation  (rev'd 11-06) (PDF 44 KB)

Form 100C - 85.27 Petition for Alternate Medical Care (rev'd 1-09) (PDF 40 KB)  Form now fillable.

Application for Deferral of Filing Fee (rev'd 7-99)
(PDF 46 KB)

Form 9 - Full Commutation  (rev'd 11-06)
(PDF 42 KB)

Form 9A - Partial Commutation  (rev'd 11-06)
(PDF 37 KB)

Hearing Report and Order Approving (new) (rev'd 6-14) or Hearing Report and Order (old)  (rev 7-99)

Release of Information - Patient Waiver  (rev'd 11-04)
(PDF 52.7 KB)

Application and Consent Order under 85.21 (rev'd 9-02)
(PDF forms/14-0037.pdf  (40 KB)

Agreement for Settlement  (rev'd 7-05)
(PDF 23 KB)

Compromise Case Settlement - 85.35(3)  rev'd 7-05)
(PDF 25 KB)

Contingent Settlement - 85.35(5)  (rev'd 7-05)
(PDF 24.5 KB)

Combination Settlement - 85.35(4)  (rev'd 7-05)
(PDF 32.5 KB)

Claimant's Statement  (rev'd 7-12)
(PDF 31.7 KB)

Payment Activity Report (PAR)  (rev'd 10-10)
(PDF 73 KB)

Copy/Information Request  (rev'd 3-10)
(PDF 31 KB)

Waiver for Release of Records  (rev'd 7-05)
(PDF 26 KB)

Fee Schedule for Copy/Data Requests (rev'd 3-10)
(PDF 32 KB)

Charge Account Application  (rev'd 4-06)
(PDF 88 KB)

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Frequently Asked Questions | Reporting Requirements | Hearing Schedule | News and Updates
Compliance Requirements | Compliance Duties | Rules | Education 
Contact and Staff | Decisions | EDI Handbook | Electronic Data Interchange (EDI)
Implementation Guides | Approved Vendors | March EDI Tables
 Forms and Publications | Related Legal Statutes and References
 Related Links | Settlements | 535.3 Interest | 2001 IWD Annual Report 
  Workers' Compensation Home Page | Iowa Workforce Development

 

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