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Submit a wage statement (DWC-3) online
Claim details
Claim number
Required
Injured worker's last name
Required
Please provide one of the following
Date of injury
Date of hire
Date of injury
Required
Date of hire
Required
Preparer's details
First name
Required
Last name
Required
Phone number
Required
Required
Email address for confirmation
Email address
Please enter a valid email address.
Confirm email address
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