.container-fluid{
width: 100%;
}
.row{
display: flex;
flex-direction: row;
gap: 20px 10px;

}
.col{
display: flex;
flex-direction: column;
flex: 1 1 33%;

padding: 20px;
}

.form__group{
display: flex;
flex-direction: column;
}

.form__group–output{
margin-bottom: 20px;
flex-direction: row;
justify-content: space-between;
align-items: center;
}

.form__label{
display: block;
box-sizing: border-box;
margin-bottom: 2px;
padding: 0;
font-weight: 700;
}
input[type=text],input[type=number],input[type=date]{
padding: 10px 6px;
border: 2px solid grey;
}
.form__helper-text{
padding: 0px;
margin: 0px;
font-size: .75rem;
}
.form__helper-text{
padding: 0px;
margin: 0px;
font-size: .75rem;
margin-bottom: 15px;
}
.form__helper-text–context{
padding: 0px;
margin: 0px;
font-size: .75rem;
font-weight: 700;
text-align: right;
}

.form__input_icon_container{
position: relative;
width: 100%;
}

.form__input_icon_container input{
width: 100%;
padding-left: 20px;
}

.form__input_icon{
position: absolute;
display: block;
transform: translate(0, -50%);
top: 50%;
pointer-events: none;
width: 25px;
text-align: center;
font-style: normal;
}

.button__container{
width: 100%;
display: flex;
flex-direction: row;
}

.form__button{
font-size: 1rem;
font-weight: 700;
text-transform: uppercase;
text-decoration: none;
letter-spacing: 0.5px;
color: #140B2D;
background-color: #FFB703;
border-radius: 0px 0px 0px 0px;
padding: 20px 30px 20px 30px;
border: none;
}

.form__button:hover{
transform: scale(1.1);
background-color:#827A98;
color: white;
}

.form__output{
display: block;
}

Use the Disability Date for the Date of Injury if it occurred in a year other than the Date of Injury. The spreadsheet will apply the lower of 66 2/3% or the State Maximum Rate for the year of the Injury. Entry of your actual amounts paid will show current status against amounts due. You will need to change the Cumulative Date on an annual basis to correspond with your filing.