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  2. Forms Repository
  3. WKC-136-E, Advance or Lump Sum Request

Advance or Lump Sum Request

Document Number: WKC-136-E

Description: This form is used when an injured worker needs to request an advancement on their permanent disability benefit or from a restricted account. The information provided is used by the division to determine if the advancement request can be approved as specified in the Worker's Compensation Act.

Comments: This form can be filled out on the computer as a fillable pdf.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-136-E (English Electronic Version) - pdf/779 KB)

WKC-136-E-S (Spanish Electronic Version - pdf/784 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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