";
print "";
print "| ";
print "First date of disability (start of award) (MM/DD/YYYY): ";
print " | ";
print "";
print textfield('ttdstartmon','',2,2), "/", textfield('ttdstartday','',2,2),"/", textfield('ttdstartyear','',4,4);
print " | ";
print "
";
print "";
print "| ";
print "Date of initial hearing (MM/DD/YYYY): ";
print " | ";
print "";
print textfield('doihmon','',2,2), "/", textfield('doihday','',2,2),"/", textfield('doihyear','',4,4);
print " | ";
print "
";
print "";
print "| ";
print "First potential date of payment (MM/DD/YYYY): ";
print " | ";
print "";
print textfield('dopmon','',2,2), "/", textfield('dopday','',2,2), "/", textfield('dopyear','',4,4);
print " | ";
print "
";
print "";
print "| ";
print "Number of days from first potential date of payment over which to calculate interest due: ";
print " | ";
print "";
print textfield('datesop','',10,10);
print " | ";
print "
";
print "";
print "| ";
print "Employee\'s weekly compensation rate: ";
print " | ";
print "";
print textfield('comprate','', 9,9);
print " | ";
print "
";
print "
";
print br;
print submit("Run interest calculation");
print " ";
print reset("Clear Form");
print end_form;
print hr;
}
if (param()) {
print header;
print "\n";
print "