Supplemental Income Benefits (SIBs) Application {DWC-52}

DWC052 - SUPPLEMENTAL INCOME BENEFITS (SIBS) APPLICATION. For the first quarter, send this form and supporting documentation to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) by the filing due date on the SIBs notification letter. For all other quarters, send application and supporting documentation to the insurance carrier by fax, mail, or email. For each week during the qualifying period, you must show active participation in a vocational rehabilitation program provided by the Texas Workforce Commission (TWC) or a private vocational rehabilitation provider; show active participation in work search efforts conducted through TWC; or show you were actively looking for a job by attaching job applications or other documents showing you have applied or asked for a job. You may use the attached work search log to track the applications you’ve submitted each week. You can attach more work search pages if needed. The number of weekly work searches is based on the county you live in. www.FormsWorkflow.com