235709
This Form is used for reporting and requesting reimbursement for transportation and travel expenses incurred in Virginia.
This document guarantees the responsibilities and obligations of a parent in Virginia. It ensures the well-being and support of a child.
This document is for preparing a final statement in a pre-mediation process for all claims in the state of Virginia.
This form is used for terminating a wage loss award in Virginia.
This form is used for reporting the annual payroll of a self-insurer in Virginia. It is required by the Virginia Workers' Compensation Commission.
This document is a full and final pre-mediation statement related to an awarded claim in the state of Virginia. It provides a comprehensive overview of the claim and its resolution prior to mediation.
This form is used for parental guarantee in Virginia for the Virginia Workers' Compensation Commission.
This Form is used for employers in Virginia to apply for a hearing.
This document is a wage chart used in Virginia for VWC Form 7A. It provides information on different wage rates for different job categories.
This Form is used for contractors in Virginia to provide proof of workers' compensation insurance coverage.
This form is used for disputing medical fee schedules in Virginia.
This document is used for certifying a business concern in the Vermont Community Development Program in Vermont.
This form is used for worker certification in the Vermont Community Development Program in the state of Vermont.
This form is used for submitting a project application in the state of Washington.
This Form is used for applying for preliminary funding status in the state of Washington.
This Form is used for applying to proceed with bid opening or negotiating a Macc (Gc/Cm) in Washington for Design/Bid/Build projects.
This form is used for applying to release retainage in the state of Washington. It allows contractors or subcontractors to request the release of funds that are being held as retainage on a construction project.
This document is used to apply for authorization to sign contracts in the state of Washington.
This document is used to report and assess ambulance agencies in the state of Vermont. It helps ensure the quality and efficacy of emergency medical services provided by these agencies.
This Form is used for making new requests in the state of Vermont.
This document is a waiver of liability form specifically for personal choice drivers in the state of Vermont. It allows drivers to release liability for any accidents or damages that may occur while operating their vehicles.
This document is a transportation needs assessment tool specifically designed for the state of Vermont. It helps analyze and evaluate the transportation requirements of the state to aid in planning and decision-making processes.
This form is used for notifying Medicaid in Vermont about the admission of a child or adolescent to an inpatient facility. It helps ensure that Medicaid is aware of the admission and can appropriately process the necessary claims and payments. This document is important for managing the healthcare needs of children and adolescents covered by Vermont Medicaid.
This form is used for requesting prior authorization for the Vermont Medicaid Eyeglass Program in Vermont.
This form is used for requesting prior authorization for a urine drug test in the state of Vermont. It helps ensure that the test will be covered by insurance.
This form is used for abortion certification in the state of Vermont.
This form is used for requesting a homestead exemption in the state of Vermont.
This form is used for applying for a Homestead Exemption in Vermont if your household income is below 300 percent of the Federal Poverty Level.
This form is used for certifying abortions in the state of Vermont.
This form is used for requesting prior authorization for Humira (Pediatric) for patients who are 18 years old or younger in the state of Vermont.