Forms
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| Forms | Format | |
| Agency Online Self-Administration Form | DOC | |
| Agency Summary Report | DOC | |
| Agent W9 | ||
| Agent's Request for Endorsement | DOC | |
| Coverage Options for Corporate Executive Officers | DOC | |
| Book of Business or Entity Change Form | DOC | |
| Employee Provider Form EP-1a | DOC | |
| Executive Supervisor Questionnaire (5606) | DOC | |
| Independent Contractor Questionnaire | DOC | |
| Installment Billing Guide | ||
| Professional Employer Organization New Client Form | DOC | |
| Professional Employer Organization Questionnaire | DOC | |
| Professional Employer Organization Requirements | DOC | |
| Start Program Supplemental Application | DOC | |
| Supplemental Application Aircraft Operations Information | DOC | |
| Supplemental Application Longshore and Harbor Workers' Compensation Act | DOC | |
| Supplemental Application Jones Act | DOC | |
| Supplemental Application Outer Continental Shelf | DOC | |
| Supplemental Employee Data Worksheet | DOC | |
| Temp Employee Data Worksheet & Client List | DOC | |
| Trucking Industry Questionnaire | DOC | |
| DWC-81, Agreement Between General Contractor and Subcontractor to Provide Workers' Compensation Insurance | ||
| DWC-82, Agreement Between Motor Carrier and Owner Operator to Provide Workers' Compensation Insurance Coverage / Agreement to Require Owner Operator to Act as Employer | ||
| DWC-83, Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers / Agreement to Establish Employer-Employee Relationship for Certain Building and Construction Workers | ||
| DWC-84, Exception to Application of Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers | ||
| DWC-85, Agreement Between General Contractor and Subcontractor to Establish Independent Relationship | ||
| Workers' Compensation- Request for Information* (WC- RFI, formerly known as the ERM-14) | DOC | |
| *Instructions for completing the WC-RFI form | ||
More forms on the Web
For more forms related to workers' compensation insurance or general workplace issues, visit the appropriate agency's website, listed below.