Agency

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  Final Admission of Liability (Prior to Aug. 5, 1998)

  COWC4 $89.00
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  Final Judgment

  TXMCFJ $25.00
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  Final Medical Report

  TNWC_C-30A $39.00
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  Final Payment Notice

  COWC25 $89.00
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  Final Report of Payment and Receipt of Compensation

  NYWC_C-29 $89.00
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  First Report of Injury or Illness

  IA-1-AR $89.00
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  First Report of Injury or Illness

  FLWC1 $89.00
• 

  First Report of Injury or Illness

  SCWC12A $89.00
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  First Report Transmittal

  COWC106 $69.00
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  Form Letter Requesting Medical Information

  NYWCDB3103 $39.00
• 

  Form PR: Monthly Production Report

  TXRRCPR $189.00
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  Form R-6 (Part 1 and 2)

  LAR6 $129.00
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  Formulator’s Exemption Statement

  8570-27 $69.00
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  Fraud and Compliance Request for Hearing or Trial Division Intervention

  GAWC24 $89.00
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  Gas Production/Royalty Report

  GLO-2 $89.00
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  Gas Severance Tax Return – Lease Detail

  LAG1D $129.00