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ADVISORY 2004-09

SUBJECT: TWCC Forms Redesign Initiative

The new TXCOMP system's imaging process will set the stage for allowing claim parties to view claim documents online. In order to streamline the document imaging process and attempt to reduce data entry or potential routing errors, TWCC has redesigned all of its forms to ensure that the TWCC claim number is always located in the top right portion of the form. TWCC forms can be downloaded using the following link:

We have also created a footer for every form that includes the standard placement of a barcode, the form name and type, revision date, and page number. The standard for the form footer is as follows:

  • "TWCC-XX (Rev MM/DD) Page X" is Arial 9pt
  • The barcode is "3 of 9" format. The barcode is ½" high and centered between the Form Number text and "TEXAS WORKERS' COMPENSATION COMMISSION" text.
  • Bottom page margin is 1/4"

The standard for the barcode itself is as follows:

  • "[FormCode][FormNumber][PageNumber]-[RevisionDate(mm/yy)]"
  • FormCode is "F" for TWCC Form or "N" for Notice (e.g. Plain Language Notices).
  • For example, the barcode for a TWCC-21 page 2 with a revision date of June 2004 would
    become F21P2-0604

THESE BARCODES AND FOOTERS MUST BE ON EACH FORM FILED WITH THE COMMISSION. Specifications for each TWCC form's barcode and footer can be found on the TWCC website using the following link:

Customers should discard all copies of prior versions of TWCC forms and begin using these redesigned forms as of the date of this Advisory. Forms that are filed with TWCC must contain the new form standards, including the barcodes and footers beginning September 30, 2004. Previous versions of the forms will not be accepted after September 30, 2004. Forms that are generated by customers for filing with other system participants, including the Explanation of Benefits (TWCC-62), Wage Statement (TWCC-3), Supplemental Report of Injury to TWCC (TWCC-6), Work Status Report (TWCC-73), and Plain Language Notices (PLN 1 and 11) should be generated using the new standards as soon as possible, but must be revised no later than August 31, 2005.

If you have any questions, contact Stacey Jefferson, Director of the Business & Technology Services Division at 512-804-4302 or send an e-mail to

Signed this 3rd day of September, 2004

Robert L. Shipe, Acting Executive Director


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