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State Forms & Regulatory Links

 

General +

Links

Occupational Safety & Health Admin. (OSHA)
U.S. Dept of Labor

Alabama +

Links

Dept of Industrial Relations and Workers Comp

Florida +

Links

Bureau of Workers’ Compensation Fraud

Georgia +

Links

State Board of Workers’ Compensation

Indiana+

Notice for Workers

Notice for Workers' Compensation & Occupational Diseases Coverage - IN

IN Notice of Election to Accept or Reject an Insurance Deductible

IN Notice of Election to Accept or Reject an Insurance Deductible

    Links

    Workers’ Compensation Board of Indiana

    Kentucky+

    Links

    Workers’ Compensation of Kentucky

    Mississippi +

    Wage Statement

    Wage Statement

    MS Notice of Election or Rejection of Workers

    MS Notice of Election or Rejection of Workers' Compensation

    MS Application for Certification of Drug-Free Workplace Program

    MS Application for Certification of Drug-Free Workplace Program

      Links

      Workers’ Compensation Commission

      North Carolina +

      NC Exemption Form

      NC Exemption Form

        Links

        Industrial Commission
        NCRB ERM-14 – Electronic Submission Only

        South Carolina +

        Links

        Workers’ Compensation Commission

        Tennessee +

        Links

        Bureau of Workers’ Compensation

        Virginia +

        VA Notice of Election of Coverage

        VA Notice of Election of Coverage

        VA Revocation of Prior Rejection of Coverage Form 17A

        VA Revocation of Prior Rejection of Coverage Form 17A

        VA Application for Drug-Free Workplace Premium Credit

        VA Application for Drug-Free Workplace Premium Credit

          Links

          Virginia Workers’ Compensation Commission
          Option to file Rejection of Coverage Waiver Form 16A