New Hampshire Department of Labor Forms

84
total templates

Documents

84

Form WCSI-1 "Workers' Compensation Self-insurance Application" - New Hampshire

Rate (4.6 / 5) 86 votes
Size: 105 KB
4 pages

Form WCSI-7 "Actuarial Opinion Summary Sheet" - New Hampshire

Rate (4.3 / 5) 54 votes
Size: 94 KB
2 pages

Form WCSIF-1 Exhibit O "Application for the Use of the Second Injury Fund" - New Hampshire

Rate (4.4 / 5) 10 votes
Size: 49 KB
1 page

Form WCSIF-2 Exhibit S "Request for Reimbursement From the Second Injury Fund" - New Hampshire

Rate (4.4 / 5) 97 votes
Size: 31 KB
1 page

Form WCSI-2 "Self-insurance Surety Bond" - New Hampshire

Rate (4.8 / 5) 87 votes
Size: 23 KB
1 page

Form WCSI-4 "Certificate of Insurance" - New Hampshire

Rate (4.3 / 5) 32 votes
Size: 17 KB
1 page

Form WCSI-6 "Parent Company Agreement" - New Hampshire

Rate (4.7 / 5) 73 votes
Size: 17 KB
1 page

Form WCSI-3 "Securities Deposit Agreement" - New Hampshire

Rate (4.8 / 5) 67 votes
Size: 21 KB
2 pages

Form WCSI-9 "Report of Outstanding Liabilities" - New Hampshire

Rate (4.9 / 5) 7 votes
Size: 114 KB
1 page

Form BC-2 "Students Participating in Approved Building Construction Programs" - New Hampshire

Rate (4.7 / 5) 18 votes
Size: 114 KB
1 page

Form WC-VR-01 "Request for Job Modification Plan Approval" - New Hampshire

Rate (4.3 / 5) 13 votes
Size: 39 KB
1 page

Form WCSIF-1C "Second Injury Fund Employee Information Sheet" - New Hampshire

Rate (4.8 / 5) 10 votes
Size: 67 KB
1 page

Form WCSI-1A "Workers' Compensation Self-insurance Application - Group" - New Hampshire

Rate (4.6 / 5) 52 votes
Size: 101 KB
4 pages

Form WCSI-16 "Self Insurance Questionnaire" - New Hampshire

Rate (4.7 / 5) 51 votes
Size: 67 KB
1 page

Form WCSIF-2A Exhibit T "Schedule of Reimbursable Payments" - New Hampshire

Rate (4.5 / 5) 88 votes
Size: 37 KB
1 page

Form WCSIF-1A Exhibit P "Second Injury Fund Affidavit of Employer Knowledge" - New Hampshire

Rate (4.6 / 5) 70 votes
Size: 15 KB
1 page

Form WCSIF-1B Exhibit Q "Second Injury Fund Certification by Physician" - New Hampshire

Rate (4.7 / 5) 47 votes
Size: 36 KB
2 pages

Form WCSI-2A "General Purpose Rider" - New Hampshire

Rate (4.6 / 5) 62 votes
Size: 12 KB
1 page

Form 8WC "Employers First Report of Injury" - New Hampshire

Rate (4.5 / 5) 19 votes
Size: 46 KB
1 page

Form PAB006 "Application for Nh Vocational Rehabilitation Provider Certification" - New Hampshire

Rate (4.4 / 5) 17 votes
Size: 39 KB
1 page

Form ELCA "License Application for Elevator Inspector, Elevator Mechanic, Accessibility Lift Mechanic, Accessibility Lift Inspector" - New Hampshire

Rate (4.6 / 5) 32 votes
Size: 89 KB
1 page

Form 53WC "Employee's Statement of Employment Status" - New Hampshire

Rate (4.7 / 5) 98 votes
Size: 40 KB
2 pages

Form 8AWCA "Notice of Accidental Injury or Occupational Disease" - New Hampshire

Rate (4.3 / 5) 35 votes
Size: 36 KB
1 page

Form 10WCA "Memo of Permanent Impairment Award" - New Hampshire

Rate (4.7 / 5) 37 votes
Size: 41 KB
1 page

Form WCTPA "Security Deposit Agreement for Third Party Administrator" - New Hampshire

Rate (4.4 / 5) 73 votes
Size: 25 KB
2 pages

Form 9 WCA "Memo of Payment of Disability Compensation" - New Hampshire

Rate (4.4 / 5) 60 votes
Size: 43 KB
1 page

Form 76 WCA "Wage Schedule" - New Hampshire

Rate (4.3 / 5) 84 votes
Size: 204 KB
1 page

Form 9WCA-2 "Application for Reimbursement of Paid Adjusted Total Disability Benefits From Special Fund for Active Cases, Rsa 281-a:29, 281-a:30" - New Hampshire

Rate (4.8 / 5) 87 votes
Size: 80 KB
1 page

Form 9WCA-3 "Application for Reimbursement of Paid Combined Earnings Differential From Special Fund for Second Injuries, Rsa 281-a:15 Iii, 281-a:55" - New Hampshire

Rate (4.3 / 5) 77 votes
Size: 90 KB
1 page

Form WC-3PR -1 "Settlement of Third-Party Claim Computation" - New Hampshire

Rate (4.3 / 5) 24 votes
Size: 134 KB
2 pages

Form 13 WCA "Employer's Supplemental Report of Injury" - New Hampshire

Rate (4.5 / 5) 29 votes
Size: 41 KB
1 page

Form 14 WCA "Authorization for Compensation for Death" - New Hampshire

Rate (4.6 / 5) 86 votes
Size: 49 KB
1 page

Form 74 WCA "Report of Extended Disability" - New Hampshire

Rate (4.8 / 5) 60 votes
Size: 64 KB
1 page

Form G45007-1 "Boiler Extension Request Form" - New Hampshire

Rate (4.6 / 5) 7 votes
Size: 232 KB
1 page

Form 23-B WC "Nh Workers' Compensation Task Analysis" - New Hampshire

Rate (4.4 / 5) 36 votes
Size: 85 KB
1 page

Form 9 WCA-1 "Memo of Denial of Workers' Compensation Benefits" - New Hampshire

Rate (4.8 / 5) 11 votes
Size: 16 KB
1 page

Form 53-A WC "Notice of Intention to Suspend Payment of Workers' Compensation Benefits" - New Hampshire

Rate (4.8 / 5) 90 votes
Size: 28 KB
1 page

Form 75 WCA-1 "New Hampshire Workers' Compensation Medical Form" - New Hampshire

Rate (4.6 / 5) 38 votes
Size: 124 KB
1 page

Form WC-TPA-BA "Biographical Affidavit" - New Hampshire

Rate (4.3 / 5) 6 votes
Size: 63 KB
5 pages