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  Payment of Compensation or Notice of Refused or Disputed Claim

  TWCC-21 $89.00
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  Payment Receipt

  TXMCPAYRCPT $15.00
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  Payment Schedules A, B, C, D, E

  FLWCPAYSCH $89.00
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  PCB Annual Document Log

  2ec58acb96b2 $275.00
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  Periodic Log for NPDES Discharge Reports

  FOAD NPDES DMR $149.00
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  Periodic Report

  SCWC18 $69.00
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  Permanent Total Off-Set Worksheets

  FLWC33 $89.00
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  Permanent Total Supplemental Worksheet

  FLWC35 $89.00
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  Permit to Drill

  COGCC02 $89.00
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  Petition for an Immediate Hearing Under Sec. 19(b)

  ILIC7 $89.00
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  Petition for Immediate Hearing Under Section 19(b-1)

  ILIC14A $89.00
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  Petition for Review of Arbitration Decision

  ILIC11 $89.00
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  Petition for Review of Arbitration Decision

  ILIC11A $89.00
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  Petition for Review Under Section 19(h) or 8(a)

  ILIC14 $89.00
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  Petition to Controvert

  MSWCB5-11 $69.00
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  Petition to Reinstate Case

  ILIC23 $89.00