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Name: Fillable Online Statement of Wages for Injuries Occurring on or After June 24, 1996 Fax Email Print - pdfFiller
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This document is used to report the wages of an employee who has sustained injuries, for the purpose of determining weekly compensation benefits under the Pennsylvania Workers’ Compensation Act. It includes sections for employee and employer information, calculations for average weekly wage, and provisions for concurrent employment.

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What is statement of wages?

A statement of wages is a document that summarizes the earnings and deductions of an employee over a specific period, typically used for reporting purposes to the government.

Who is required to file statement of wages?

Employers who pay wages to employees are required to file a statement of wages, including businesses and organizations that have employees under their payroll.

How to fill out statement of wages?

To fill out a statement of wages, an employer must accurately enter employee details, total earnings, deductions, and ensure all information complies with local regulations before submitting it to the relevant tax authorities.

What is the purpose of statement of wages?

The purpose of a statement of wages is to report tax information regarding employee income to tax authorities, ensure compliance with payroll regulations, and maintain accurate employee records.

What information must be reported on statement of wages?

Information that must be reported includes employee name, Social Security number, total wages paid, federal taxes withheld, state taxes withheld, and other deductions.

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