Workers Compensation ACORD Forms

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ACORD 4 - Workers Compensation - First Report of Injury or Illness
ACORD 64US - Insurance Supplement - Workers' Compensation Only
ACORD 125 - Commercial Insurance Application - Applicant Information Section
ACORD 130 - Workers Compensation Application
ACORD 133 - Workers Compensation Insurance Plan Assigned Risk Section


Alaska Workers Compensation ACORD Forms

ACORD 171AK - Alaska Petition for Executive Officer Waiver


Colorado Workers Compensation ACORD Forms

ACORD 171CO - Colorado Rejection of Coverages by Corporate Officers


Connecticut Workers Compensation ACORD Forms

ACORD 171CT - Workers' Compensation Commission of Connecticut
ACORD 172CT - Workers' Compensation Commission of Connecticut
ACORD 173CT - Workers' Compensation Commission of Connecticut


Delaware Workers Compensation ACORD Forms

ACORD 171DE - Delaware Workers Compensation


Florida Workers Compensation ACORD Forms

ACORD 130FL - Florida Workers Compensation Application
ACORD 133FL - Florida Workers Compensation Application
ACORD 134FL - Florida Workers Compensation Joint Underwriting Association Inc.
ACORD 171FL - Florida Notice of Election of Coverage Under Workers Compensation Law
ACORD 172FL - Florida Revocation of Election to be Exempt
ACORD 173FL - Notice of Election to be Exempt
ACORD 175FL - Florida Workers Compensation Monthly Change Sheet


Georgia Workers Compensation ACORD Forms

ACORD 171GA - Georgia State Board of Workers Compensation Notice of Election or Rejection of Workers' Compensation Coverage


Kansas Workers Compensation ACORD Forms

ACORD 171KS - Kansas Election of Individual Partner or Self-Employed Individual
ACORD 172KS - Kansas Cancellation of Election of Individual
ACORD 173KS - Kansas Cancellation of Election Not to Accept Coverage
ACORD 174KS - Kansas Election Not to Accept Coverage
ACORD 176KS - Kansas Election of Employer to Cover Employees
ACORD 177KS - Kansas Election of Coverage for Volunteer Workers
ACORD 178KS - Kansas Cancellation of Election of Employer To Cover Employees
ACORD 179KS - Kansas Cancellation of Election of Coverage for Volunteer Workers
ACORD 180KS - Kansas Election of Coverage for Persons Performing Public Service
ACORD 181KS - Kansas Cancellation of Election of Coverage for Persons Performing Public Service
ACORD 182KS - Kansas Election of a Noncompensated Volunteer To Be Covered
ACORD 183KS - Kansas Cancellation of Election of a Noncompensated Volunteer To Be Covered


Michigan Workers Compensation ACORD Forms

ACORD 133MI - Michigan Application for Workers' Compensation Insurance
ACORD 171MI - Michigan Notice of Election
ACORD 172 - Michigan Application for Exclusion of Partner(s)
ACORD 173MI - Michigan Workers Compensation Placement Facility Specific Person Exclusion Form


New Jersey Workers Compensation ACORD Forms

ACORD 132NJ - New Jersey Workers Compensation Insurance Plan Instructions and Rules
ACORD 133NJ - New Jersey Workers Compensation Insurance Plan Application
ACORD 134NJ - New Jersey Workers Compensation Insurance Plan Notice of Election - Proprietors and Partners
ACORD 135NJ - New Jersey Workers Compensation Insurance Plan - Supplemental Employee Leasing Application
ACORD 136NJ - New Jersey Workers Compensation Insurance Plan - Truckers Supplemental Application
ACORD 171NJ - New Jersey Workers Compensation Insurance Plan - New Jersey Workers Compensation and Employers Liability Manual, Part 3, Sectino 14


New Mexico Workers Compensation ACORD Forms

ACORD 171NM - New Mexico Executive Employee Exemption
ACORD 172NM - New Mexico Election to Accept
ACORD 173NM - New Mexico Revocation


New York Workers Compensation ACORD Forms

ACORD 171NY - New York Notice of Election of a Corporation
ACORD 172NY - New York Notice of Election of a Partnership or Sole Proprietorship to Bring Partners or Self-Employed Persons Under the Coverage of the New York Workers Compensation Law
ACORD 173NY - New York Notice of Election of an Incorporated Religious
ACORD 174NY - New York Revocation of an Incorporated Religious


North Carolina Workers Compensation ACORD Forms

ACORD 133NC - North Carolina workers Compensation Insurance Plan
ACORD 134NC - North Carolina Workers Compensation Insurance Plan


Pennsylvannia Workers Compensation ACORD Forms

ACORD 171PA - Pennsylvania Application for Executive Officer Exception From the Provisions of the Pennsylvania Workers' Compensation Act: Section 104
ACORD 172PA - Pennsylvania Executive Officers Declaration


Tennessee Workers Compensation ACORD Forms

ACORD 133TN - Tennessee Workers Compensation Insurance Plan Assigned Risk Supplement
ACORD 171TN - Notice of Corporate Officer to Employer of Election Not to ACcept Provisions of
ACORD 172TN - Notice of Corporate Officer's Revocation of Exemption
ACORD 173TN - Election of Sole Proprietor or Partner to Come Within the Provisions of the Tennessee Workers' Compensation Law
ACORD 174TN - Notice of Withdrawal of Sole Proprietor or Partner Election


Virginia Workers Compensation ACORD Forms

ACORD 171VA - Virginia Rejection of Coverage Under the Virginia Workers' Compensation Act
ACORD 172VA - Virginia Notice Terminating Prior Rejection of Coverage


Wisconsin Workers Compensation ACORD Forms

ACORD 4WI - Wisconsin Employer's First Report of Injury or Disease