REGULATORY LINKS / FORMS

GENERAL FORMS

• Credit Card Authorization
• ACORD 130
• ACORD 130 FL
• Employee List
• NCCI ERM-14 Form
• NCCI ERM-6 Form
• NCCI ERM-6 Instructions
• Waiver of Subrogation UW Criteria

GENERAL LINKS

U.S. Department of Labor: www.dol.gov
Occupational Safety & Health Admin. (OSHA) www.osha.gov
ACORD : www.ACORD.org
NCCI: www.ncci.com

STATE SPECIFIC FORMS & RELATED LINKS

Alabama | Florida | Georgia | Kentucky | Mississippi | North Carolina | South Carolina | Tennessee

Alabama

	Employers Notice to Exclude or Include Coverage for Himself, Officers or Members
	Alabama Application for Certification of Drug-Free Workplace Premium Credit
	Alabama Application for Re-Certification of Drug-Free Workplace Premium Credit

Alabama Department of Industrial Relations/WC
http://www.dir.alabama.gov

Alabama Department of Insurance
http://www.aldoi.gov

State of Alabama
http://www.alabama.gov

top

Florida

	Notice of Election to be Exempt
	Instructions for Completing Notice of Election to be Exempt
	Notice of Revocation of Election to be Exempt
	Notice of Election of Coverage
	Revocation of Election of Coverage
	Florida Application for Drug-Free Workplace Premium Credit
	Florida Certification of Employer Workplace Safety Program Premium Credit

Fraud
http://www.fldfs.com/fraud

Florida Department of Financial Services
http://www.fldfs.com

Florida Department of State
http://www.sunbiz.org

Official Portal of the State of Florida
http://www.myflorida.com

Florida Government
http://www.leg.state.fl.us

top

Georgia

	Georgia State Board of Workers' Compensation Notice of Election or Rejection of Workers' Compensation Coverage
	Georgia Application for Certification or Annual Recertification of Drug-Free Workplace Premium Credit

Georgia Insurance and Safety Fire Commissioner
http://www.inscomm.state.ga.us

Georgia Department of Insurance
http://www.gainsurance.org

Georgia State Board of Workers’ Compensation
http://www.sbwc.georgia.gov/

State of Georgia Secretary of State
http://www.sos.georgia.gov

Georgia Government
http://www.georgia.gov

Georgia Producer Appointment Form
http://www.gainsurance.org/Agents/Forms-Agents.aspx

top

Kentucky

	Kentucky Employee's Notice of Rejection of Workers' Compensation Act
	Kentucky Application for Certification of Drug-Free Workplace Program

Kentucky Department of Labor/Office of Workers' Claims
http://www.labor.ky.gov

Kentucky Office of Insurance
http://doi.ppr.ky.gov/Kentucky/

Kentucky Secretary of State
http://www.sos.ky.gov

top

Mississippi

	Notice of Election or Rejection of Workers' Compensation for the State of Mississippi
	Mississippi Application for Drug-Free Workplace Premium Credit

Mississippi Workers’ Compensation Commission
http://www.mwcc.state.ms.us

Mississippi Department of Insurance
http://www.mid.state.ms.us

Mississippi Secretary of State
http://www.sos.state.ms.us

top

North Carolina

North Carolina Department of Insurance
http://www.ncdoi.com/

North Carolina Rate Bureau
http://www.ncrb.org/ncrb/

North Carolina Department of the Secretary of State
http://www.sosnc.com/

North Carolina Industrial Commission
http://www.ic.nc.gov/

top

South Carolina

	South Carolina Corporate Officer Notice to Reject
	South Carolina Application for Drug-and Alcohol-Free Workplace Premium Credit

South Carolina Workers' Compensation Commission
http://wcc.sc.gov/Welcome+and+Overview/Workers+Comp+SC/

South Carolina Secretary of State
http://www.scsos.com

Other Forms
http://www.wcc.state.sc.us/Welcome+and+Overview/Forms/

South Carolina Department of Insurance
http://www.doi.sc.gov/

top

Tennessee

	Notice of Corporate Officer to Employer of Election Not to Accept Provisions Of "Workers' Compensation Act" of Tennessee
	Tennessee Application for Drug-Free Workplace Premium Credit

Tennessee Department of State
http://www.state.tn.us/sos/

Tennessee Department of Labor & Workforce Development
http://www.state.tn.us/labor-wfd/wcomp.html

Tennessee Department of Commerce and Insurance
http://www.state.tn.us/commerce/