Forms and Publications

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Title Number / Language
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Functional Recovery Interventions (RFI) Tracking Sheet  F245-420-000 (English)
SIF-5A Cover Sheet: Wage Calculations  F207-156-000 (English)
Application for Elective Coverage - Sole Proprietor, Partners, For-Profit Corporate Officers, or Member/Managers of Limited Liability Company (LLC)  F213-042-000 (English)
Application for Elective Coverage of Excluded Employments  F213-112-000 (English)
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)  F213-113-000 (English)
Application for Limited Elective Coverage for Licensed Pony Riders  F250-026-000 (English)
Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers  F213-004-000 (English)
Cancellation of Elective Coverage for Excluded Employments  F213-005-000 (English)
Certificate of Coverage - SAMPLE ONLY  F211-141-000 (English)
 F211-141-999 (Spanish)
Coverage Agreement  F212-044-000 (English)
Independent Contractor or Covered Worker? - Your rights to workers' compensation, minimum wage and overtime  F212-250-000 (English)
 F212-250-999 (Spanish)
Independent Medical Examination Fax Cover Sheet  F245-383-000 (English)
Know What to Expect: How Recoveries and Settlements May Impact Your Crime Victim Claim  F800-074-000 (English)
Maritime Coverage  F212-034-000 (English)
Massage Therapist: Independent Contractor or Covered Worker?  F212-248-000 (English)
Overpayment Reimbursement Fund Request Coversheet  F207-212-000 (English)
Resume Cover Sheet  F242-418-000 (English)
Self-Insurance Vocational Services Closing Cover Sheet  F207-171-000 (English)
Sports Player Coverage Agreement  F212-242-000 (English)
Sports Teams Coverage Agreement  F212-196-000 (English)
Student Volunteers and Workers' Compensation Coverage  F213-023-000 (English)
Third Party Recovery Worksheet  F249-006-111 (English)
Window Cleaning Service and Recovery Plan  F417-273-000 (English)
Workers' Compensation Coverage for Wineries  F212-249-000 (English)





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