Temporary Partial Disability Calculation Worksheet
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Temporary Partial Disability Calculation Worksheet Form. This is a Nevada form and can be use in Workers Comp.
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Tags: Temporary Partial Disability Calculation Worksheet, D-46, Nevada Workers Comp,
Temporary Partial Disability Calculation Worksheet (NAC 616C.598(7)) For Claims Agents Use Injured Employee Insurer Third-Party Administrator Employer Claim Number SSN Pay Period (From) / / Paid: Weekly Pay Period (To) / / Bi-Weekly Semi-Monthly Monthly Gross Wage $ SSTax/FICA $ Days Not Included in Pay Period Medicare $ Reason for Absence: FIT/FWT $ Other (define) $ Net Wage $ (after the usual deductions are made for social security, income taxes and other required state or federal deductions) Pursuant to NAC 616C.598(2). TTD $ (for the same period) Net Wage - $ TPD due $ (if the net pay is greater than the TTD rate, there is no entitlement to TPD) Pursuant to NAC 616C.598(1). Prepared By Date D-46 (7/99)
