Get the free WH-1 Wage Benefit Claim Form.pf - labor vermont

Wage and Hour Program P.O. Box 488 Montpelier, VT 05601-0488 Telephone: 802-828-0267 FAX: 802-828-4198 E-Mail: Labor-Wagehour state.VT.us For Office Use Only Vermont Department of Labor WAGE / BENEFIT

How to fill out wh-1 wage benefit claim

Who needs wh-1 wage benefit claim?

1. Employers who wish to provide wage replacement benefits to their employees who are unable to work due to a nonwork-related illness or injury.
2. Employees who are unable to work due to a nonwork-related illness or injury and want to apply for wage replacement benefits.

How to fill out wh-1 wage benefit claim:

1. Obtain the wh-1 wage benefit claim form from the appropriate source, such as the state's labor department website or local employment office.
2. Fill in the basic information at the top of the form, including your name, address, and contact information.
3. Provide your employer's information, such as the company name, address, and contact details.
4. Fill in your job title, start and end dates of employment, and average weekly wage.
5. Indicate the dates of your illness or injury and whether it is work-related or nonwork-related.
6. Attach any supporting documentation, such as medical reports or doctor's notes, if required.
7. Sign and date the form, certifying that the information provided is true and accurate to the best of your knowledge.
8. Submit the completed form to the appropriate agency or employer as instructed on the form.
9. Keep a copy of the completed form for your records.
10. Follow up with the agency or employer to ensure that your claim is being processed and to address any additional requirements or steps.

Note: It is recommended to refer to the specific instructions provided with the wh-1 wage benefit claim form for detailed guidance on filling it out correctly.

For pdfFiller’s FAQs

What is wh-1 wage benefit claim?

The wh-1 wage benefit claim is a form used to claim benefits under the Wage Replacement Program for Workers with COVID-19.

Who is required to file wh-1 wage benefit claim?

Workers who have been diagnosed with or are suspected of having COVID-19 and are unable to work as a result are required to file a wh-1 wage benefit claim.

How to fill out wh-1 wage benefit claim?

To fill out the wh-1 wage benefit claim, workers must provide information about their diagnosis, treatment, and inability to work due to COVID-19.

What is the purpose of wh-1 wage benefit claim?

The purpose of the wh-1 wage benefit claim is to provide financial assistance to workers who are unable to work due to COVID-19.

What information must be reported on wh-1 wage benefit claim?

Information that must be reported on the wh-1 wage benefit claim includes details about the worker's diagnosis, treatment, and inability to work.

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