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SELF-INSURED EMPLOYER OR CARRIER MAIL TO FORM 22 10/2006 PAGE 1 OF 2 NCIC - CLAIMS SECTION 4335 MAIL SERVICE CENTER RALEIGH NC 27699-4335 TELEPHONE 919 807-2502 HELPLINE 800 688-8349 WEBSITE HTTP //WWW.IC. North Carolina Industrial Commission IC File STATEMENT OF DAYS WORKED AND EARNINGS OF INJURED EMPLOYEE Emp. Code Carrier Code Carrier File The Use Of This Form Is Required Under The Provisions of The Workers...
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