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Full Name
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First
Last
Employee Phone Number
Employer Business Name
*
Employer Contact Name
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Employer Contact Phone
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Date of Injury
How much work has the employee missed?
How much work has the employee missed?
3 days or fewer
More than 3 days
Injury Detail
Email
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Payroll Documents
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IRS Form W-4 – Employee’s Withholding Certificate – 2020
Omaha National – Holiday Payroll Processing Schedule
Omaha National Form – Employee ACH Authorization
Omaha National Form – Employee Acknowledgements
Omaha National Form – Payroll Deduction Authorization