Stipulations with Request for Award Coversheet data, SSN and venue location Applicant name and address If there is an Employer then there has to be a Claims Administrator Injured worker name and address. Permanent or temporary disability information. Information to compute the attorney fee Limited to 256 characters Contains the SSN, Date of Injury and Venu information All the disability payment information Optional, however, is the TemporaryDisabilityStartDate is entered then the EndDate and Amount are required Optional, however if the Start date is entered then the endDate, rate and amount are required. The permanent disability amount, start and end dates Limited to 12 characters Radio buttons indicating the need for medical treatment to cure or relieve effects Limited to 189 characters Limited to 440 characters Interpreter name and license number Other stipulation information