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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-141 (BWC-1268)
for the current year.
Form C-141 (BWC-1268) Wage Loss Statement for Job Search - Ohio
What Is Form C-141 (BWC-1268)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-141 (BWC-1268)?
A: Form C-141 (BWC-1268) is a Wage Loss Statement for Job Search specific to Ohio.
Q: What is the purpose of Form C-141 (BWC-1268)?
A: The purpose of Form C-141 (BWC-1268) is to document the wage loss incurred by an injured worker during their job search.
Q: Who needs to complete Form C-141 (BWC-1268)?
A: The injured worker, along with the treating physician, employer, or Managed Care Organization (MCO), may need to complete Form C-141 (BWC-1268).
Q: When should Form C-141 (BWC-1268) be completed?
A: Form C-141 (BWC-1268) should be completed when an injured worker is actively searching for employment after a work-related injury.
Q: Are there any filing fees for Form C-141 (BWC-1268)?
A: No, there are no filing fees for Form C-141 (BWC-1268).
Q: What information is required on Form C-141 (BWC-1268)?
A: Form C-141 (BWC-1268) requires information such as the injured worker's personal details, employment history, job search efforts, and any wages earned during the job search period.
Q: What is the deadline for submitting Form C-141 (BWC-1268)?
A: The deadline for submitting Form C-141 (BWC-1268) is typically within a specified timeframe after the completion of each reporting period.
Q: What happens after submitting Form C-141 (BWC-1268)?
A: After submitting Form C-141 (BWC-1268), the Ohio Bureau of Workers' Compensation (BWC) will review the information provided and determine the appropriate compensation for wage loss during the job search.
Form Details:
- Released on March 25, 2009;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form C-141 (BWC-1268) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
