Insurance Forms and Templates

41
total templates

Documents

41

Form CMS-1500 "Health Insurance Claim Form"

Rate (4.4 / 5) 28 votes
Size: 1 MB
4 pages

Physicians and other healthcare providers and professionals may use this legal document to submit claims for medical services. Form CMS-1500 provides information about the patient and insured, their diagnosis, treatment, and insurance details.

Form UB-106-A-FF "Weekly Claim for Unemployment Insurance (Ui) Benefits" - Arizona

Rate (4.4 / 5) 163 votes
Size: 235 KB
2 pages

This is an Arizona legal document needed to verify that you were unemployed during the report week and are eligible to receive Arizona Unemployment Insurance or AZUI.

Form B-2 "Claimant Change of Address Form" - Vermont

Rate (4.4 / 5) 17 votes
Size: 86 KB
1 page

Form MODES-DUA-16 "Disaster Unemployment Assistance (Dua) Information for Filing a Claim" - Missouri

Rate (4.8 / 5) 28 votes
Size: 93 KB
1 page

DOL Form B-12 "Ui Claimant Appeal Form" - Vermont

Rate (4.4 / 5) 42 votes
Size: 11 KB
1 page

Form VEC-CW-31 "Combined Wage Claim Cancellation Request" - Virginia

Rate (4.7 / 5) 18 votes
Size: 20 KB
1 page

Form B-652 "Claimant's Waiver and Authorization to Release Information" - Colorado

Rate (4.6 / 5) 77 votes
Size: 39 KB
1 page

Form DOL-421 "Weekly Claim Form for Unemployment Insurance Desk Certification" - Georgia (United States)

Rate (4.6 / 5) 68 votes
Size: 49 KB
1 page

Form UC-275 "Request for Withdrawal of Claim" - Hawaii

Rate (4.6 / 5) 12 votes
Size: 23 KB
2 pages

Form K-BEN314 "Labor Dispute Statement - Claimant" - Kansas

Rate (4.6 / 5) 98 votes
Size: 164 KB
1 page

Form HCFA-1500 "Health Insurance Claim Form"

Rate (4.5 / 5) 21 votes
Size: 21 KB
2 pages

Form CLI001F (SN4227) "Unemployment Insurance Claim Application" - Illinois

Rate (4.6 / 5) 15 votes
Size: 1 MB
5 pages

Form BPC039L "Interstate Intercept Claimant Agreement Statement" - Illinois

Rate (4.3 / 5) 18 votes
Size: 411 KB
1 page

Form K-BEN3110 "Claimant Separation Statement" - Kansas

Rate (4.6 / 5) 56 votes
Size: 136 KB
2 pages

Form K-BEN3136 "Reasonable Assurance Statement - Claimant" - Kansas

Rate (4.3 / 5) 85 votes
Size: 187 KB
1 page

Form K-BEN3121 "Bonus Pay - Claimant" - Kansas

Rate (4.7 / 5) 48 votes
Size: 86 KB
1 page

Form K-BEN3119 "Separation Pay Statement - Claimant" - Kansas

Rate (4.4 / 5) 84 votes
Size: 211 KB
1 page

Form MODES-4607 "Claimant Request for Appeal" - Missouri

Rate (4.6 / 5) 14 votes
Size: 84 KB
1 page

Form NHES0180 "Continued Claim Form" - New Hampshire

Rate (4.3 / 5) 8 votes
Size: 75 KB
2 pages

Form NHES0402 "Pathway to Work Continued Claim Form" - New Hampshire

Rate (4.5 / 5) 23 votes
Size: 82 KB
1 page

Form 1697 "Initial Claim Form" - Oregon

Rate (4.6 / 5) 16 votes
Size: 187 KB
2 pages

Form 2544 "Weekly Claim Form - Self Employment Assistance (Sea) Program" - Oregon

Rate (4.3 / 5) 19 votes
Size: 96 KB
1 page

Form LB-0487 "Joint Low Earnings and Claim for Benefits for Partial Unemployment" - Tennessee

Rate (4.3 / 5) 61 votes
Size: 79 KB
2 pages

DWS-UI Form 680Q "Claimant Statement of Voluntary Quit" - Utah

Rate (4.8 / 5) 8 votes
Size: 197 KB
2 pages

DWS-UI Form 680T "Claimant Statement of Job Discharge" - Utah

Rate (4.8 / 5) 26 votes
Size: 304 KB
2 pages

State Form 56625 "Claimant Request for Notice by Mail" - Indiana

Rate (4.7 / 5) 16 votes
Size: 1 MB
1 page

Form SFN59872 "Claimant's Affidavit of Federal Civilian Service Wages and Reason for Separation - Ucfe" - North Dakota

Rate (4.3 / 5) 9 votes
Size: 166 KB
1 page

DWS-UI Form 615CV "Statement Regarding Claims for Benefits" - Utah

Rate (4.4 / 5) 17 votes
Size: 44 KB
1 page

DWS-UI Form 615CW "Statement Regarding Claim for Benefits - Worker's Comp" - Utah

Rate (4.5 / 5) 25 votes
Size: 75 KB
1 page

Form K-BEN3118-A "Job Refusal Statement - Claimant" - Kansas

Rate (4.6 / 5) 14 votes
Size: 189 KB
1 page

Form MODES-4640-R "Request for Reemployment Trade Adjustment Assistance Claim" - Missouri

Rate (4.5 / 5) 19 votes
Size: 1 MB
2 pages

Form NHES0180 T "Training Continued Claim Form" - New Hampshire

Rate (4.4 / 5) 24 votes
Size: 73 KB
1 page

Form 60-0221 "Affidavit and Power of Attorney for Claimant" - Iowa

Rate (4.6 / 5) 9 votes
Size: 306 KB
1 page

Form 69-0005 "Claimant Affidavit of Alternate Base Period Wage Information" - Iowa

Rate (4.9 / 5) 7 votes
Size: 1 MB
1 page

Form UI-17-0299 "Weekly Claim Form" - Washington

Rate (4.8 / 5) 14 votes
Size: 193 KB
2 pages

Form DFS-F2-DWC-49 "Aggregate Claims Administration Change Report" - Florida

Rate (4.3 / 5) 43 votes
Size: 53 KB
2 pages

"Claim Record" - New Jersey

Rate (4.7 / 5) 16 votes
Size: 105 KB
1 page

"Claimant Request for Hearing" - New York

Rate (4.8 / 5) 8 votes
Size: 29 KB
1 page

"Claimant Change of Name and Address" - South Dakota

Rate (4.3 / 5) 12 votes
Size: 104 KB
1 page

"Request for Claim Cancellation" - Virginia

Rate (4.6 / 5) 17 votes
Size: 45 KB
1 page