Rhode Island Department of Labor and Training Forms
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Form DLT-WRS-2 "Prevailing Wage Complaint Form" - Rhode Island (English/Spanish)
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15 votes
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Form DWC-EB2 "Rescission of Agreement for Electronic Payment of Workers' Compensation Benefits" - Rhode Island
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47 votes
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Form DWC-EB1 "Agreement for Electronic Payment of Workers' Compensation Benefits" - Rhode Island
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Form DLT-WRS-4 "Rhode Island Certified Prevailing Wage Daily Log" - Rhode Island
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39 votes
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Form RI SI-2 "Application for Approval of Workers' Compensation Self-insurance Program" - Rhode Island
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16 votes
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113 KB
5 pages
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Form RI SI-5 "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island
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15 votes
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Form RI SI-9 "Certificate" - Rhode Island
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11 votes
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Form RI SI7 "Escrow Agreement" - Rhode Island
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12 votes
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78 KB
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Form DWC-20 "Non-prejudicial Agreement" - Rhode Island
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17 votes
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165 KB
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Form DWC-02 "Memorandum of Agreement" - Rhode Island
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29 votes
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Form DWC-04 "Employee's Certificate of Dependency Status" - Rhode Island
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27 votes
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Form DWC-05 "Suspension Agreement and Receipt" - Rhode Island
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24 votes
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Form DWC-30 "Wage Transcript" - Rhode Island
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8 votes
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Form DWC-21 "Termination of Benefits" - Rhode Island
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9 votes
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Form DLT-L-75 "Special Limited Permit to Work for a Minor 14-15 Years of Age" - Rhode Island
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23 votes
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Form DWC-24 "Mutual Agreement" - Rhode Island
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8 votes
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Form RI SI-2A "Renewal Application for Approval of Workers' Compensation Self-insurance Program" - Rhode Island
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10 votes
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142 KB
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Form RI SI-5A "Surety Bond Extension Agreement" - Rhode Island
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9 votes
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122 KB
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Form RI SI-5B "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island
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25 votes
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Form DWC-11 "Notice of Claim of Common Law Rights Pursuant to R.i.g.l. 28-29-17" - Rhode Island
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6 votes
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Form DWC-36 "Coordination of Retirement Benefits" - Rhode Island
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12 votes
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Form DWC-25 "Report of Earnings" - Rhode Island
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9 votes
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198 KB
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Form DWC-31 "Employee's Objection to Wage Transcript" - Rhode Island
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19 votes
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Form DWC-50 "Itemized Statement of Compensation" - Rhode Island
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6 votes
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149 KB
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Form DLT-L-77 "Intention to Employ Minor" - Rhode Island
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21 votes
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Form RI SI-17 "Self-insurance Agreement" - Rhode Island
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5 votes
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116 KB
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Form RI SI-7A "Trust Agreement" - Rhode Island
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12 votes
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Form RI SI-7B "Certificate of Deposit Agreement" - Rhode Island
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6 votes
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Form RI SI-10 "Indemnity Agreement by the Parent Corporation for Wholly Owned Subsidiary or if Applicable Partially Owned or Controlled Affiliate" - Rhode Island
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11 votes
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74 KB
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Form RI SI-5C "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island
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29 votes
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146 KB
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Form DWC-03S "Seasonal Wage Statement" - Rhode Island
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60 votes
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205 KB
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Form DWC-03P "Part-Time Wage Statement" - Rhode Island
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87 votes
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248 KB
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Form DWC-03F "Full-Time Wage Statement" - Rhode Island
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34 votes
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301 KB
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Form RI SI-17B "Self-insurance Agreement Continuation, Extension and/Or Amendment" - Rhode Island
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17 votes
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59 KB
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Form DWC-11-C "Election by Exempt Corporate Officer to Become Subject to Workers' Compensation" - Rhode Island
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35 votes
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21 KB
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Form DWC-11-R "Rescind Notice of Claim of Common Law Rights" - Rhode Island
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92 votes
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Form DWC-11-IC "Notice of Designation as Independent Contractor Pursuant to Rigl 28-29-17.1" - Rhode Island
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74 votes
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Form DWC-11-ICR "Notice of Withdrawal of Designation as Independent Contractor Pursuant to Rigl 28-29-17.1" - Rhode Island
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31 votes
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"Application Request for Employee BI-Weekly Pay" - Rhode Island
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10 votes
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"Non-payment of Wages Complaint Form" - Rhode Island
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7 votes
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![Form DLT-WRS-2 "Prevailing Wage Complaint Form" - Rhode Island (English/Spanish)](https://data.templateroller.com/pdf_docs_html/1906/19062/1906218/form-dlt-wrs-2-prevailing-wage-complaint-form-rhode-island-english-spanish.png "Form DLT-WRS-2 "Prevailing Wage Complaint Form" - Rhode Island (English/Spanish)")
![Form DWC-EB2 "Rescission of Agreement for Electronic Payment of Workers' Compensation Benefits" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1909/19095/1909513/form-dwc-eb-2-rescission-agreement-electronic-payment-workers-compensation-benefits-rhode-island.png "Form DWC-EB2 "Rescission of Agreement for Electronic Payment of Workers' Compensation Benefits" - Rhode Island")
![Form DWC-EB1 "Agreement for Electronic Payment of Workers' Compensation Benefits" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1909/19095/1909512/form-dwc-eb-1-agreement-electronic-payment-workers-compensation-benefits-rhode-island.png "Form DWC-EB1 "Agreement for Electronic Payment of Workers' Compensation Benefits" - Rhode Island")
![Form DLT-WRS-4 "Rhode Island Certified Prevailing Wage Daily Log" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1905/19055/1905543/form-dlt-wrs-4-rhode-island-certified-prevailing-wage-daily-log-rhode-island.png "Form DLT-WRS-4 "Rhode Island Certified Prevailing Wage Daily Log" - Rhode Island")
![Form RI SI-2 "Application for Approval of Workers' Compensation Self-insurance Program" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1905/19054/1905421/form-ri-si-2-application-for-approval-of-workers-compensation-self-insurance-program-rhode-island.png "Form RI SI-2 "Application for Approval of Workers' Compensation Self-insurance Program" - Rhode Island")
![Form RI SI-5 "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035647/form-ri-si-5-bond-of-employer-authorized-to-pay-workers-compensation-benefits-directly-to-employees-or-their-dependents-rhode-island.png "Form RI SI-5 "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island")
![Form RI SI-9 "Certificate" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035655/form-ri-si-9-certificate-rhode-island.png "Form RI SI-9 "Certificate" - Rhode Island")
![Form RI SI7 "Escrow Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035654/form-ri-si7-escrow-agreement-rhode-island.png "Form RI SI7 "Escrow Agreement" - Rhode Island")
![Form DWC-20 "Non-prejudicial Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035635/form-dwc-20-non-prejudicial-agreement-rhode-island.png "Form DWC-20 "Non-prejudicial Agreement" - Rhode Island")
![Form DWC-02 "Memorandum of Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035641/form-dwc-02-memorandum-of-agreement-rhode-island.png "Form DWC-02 "Memorandum of Agreement" - Rhode Island")
![Form DWC-04 "Employee's Certificate of Dependency Status" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035640/form-dwc-04-employee-s-certificate-of-dependency-status-rhode-island.png "Form DWC-04 "Employee's Certificate of Dependency Status" - Rhode Island")
![Form DWC-05 "Suspension Agreement and Receipt" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035636/form-dwc-05-suspension-agreement-and-receipt-rhode-island.png "Form DWC-05 "Suspension Agreement and Receipt" - Rhode Island")
![Form DWC-30 "Wage Transcript" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035639/form-dwc-30-wage-transcript-rhode-island.png "Form DWC-30 "Wage Transcript" - Rhode Island")
![Form DWC-21 "Termination of Benefits" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035637/form-dwc-21-termination-of-benefits-rhode-island.png "Form DWC-21 "Termination of Benefits" - Rhode Island")
![Form DLT-L-75 "Special Limited Permit to Work for a Minor 14-15 Years of Age" - Rhode Island](https://data.templateroller.com/pdf_docs_html/10/103/10385/form-dlt-l-75-special-limited-permit-to-work-for-a-minor-14-15-years-of-age-rhode-island.png "Form DLT-L-75 "Special Limited Permit to Work for a Minor 14-15 Years of Age" - Rhode Island")
![Form DWC-24 "Mutual Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035638/form-dwc-24-mutual-agreement-rhode-island.png "Form DWC-24 "Mutual Agreement" - Rhode Island")
![Form RI SI-2A "Renewal Application for Approval of Workers' Compensation Self-insurance Program" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035653/form-ri-si-2a-renewal-application-for-approval-of-workers-compensation-self-insurance-program-rhode-island.png "Form RI SI-2A "Renewal Application for Approval of Workers' Compensation Self-insurance Program" - Rhode Island")
![Form RI SI-5A "Surety Bond Extension Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035646/form-ri-si-5a-surety-bond-extension-agreement-rhode-island.png "Form RI SI-5A "Surety Bond Extension Agreement" - Rhode Island")
![Form RI SI-5B "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035650/form-ri-si-5b-bond-of-employer-authorized-to-pay-workers-compensation-benefits-directly-to-employees-or-their-dependents-rhode-island.png "Form RI SI-5B "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island")
![Form DWC-11 "Notice of Claim of Common Law Rights Pursuant to R.i.g.l. 28-29-17" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1905/19054/1905418/form-dwc-11-notice-of-claim-of-common-law-rights-pursuant-to-r-i-g-l-28-29-17-rhode-island.png "Form DWC-11 "Notice of Claim of Common Law Rights Pursuant to R.i.g.l. 28-29-17" - Rhode Island")
![Form DWC-36 "Coordination of Retirement Benefits" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1904/19045/1904554/form-dwc-36-coordination-of-retirement-benefits-rhode-island.png "Form DWC-36 "Coordination of Retirement Benefits" - Rhode Island")
![Form DWC-25 "Report of Earnings" - Rhode Island](https://data.templateroller.com/pdf_docs_html/598/5982/598254/form-dwc-25-report-of-earnings-rhode-island.png "Form DWC-25 "Report of Earnings" - Rhode Island")
![Form DWC-31 "Employee's Objection to Wage Transcript" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035642/form-dwc-31-employee-s-objection-to-wage-transcript-rhode-island.png "Form DWC-31 "Employee's Objection to Wage Transcript" - Rhode Island")
![Form DWC-50 "Itemized Statement of Compensation" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035643/form-dwc-50-itemized-statement-of-compensation-rhode-island.png "Form DWC-50 "Itemized Statement of Compensation" - Rhode Island")
![Form DLT-L-77 "Intention to Employ Minor" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1914/19147/1914703/form-dlt-l-77-intention-to-employ-minor-rhode-island.png "Form DLT-L-77 "Intention to Employ Minor" - Rhode Island")
![Form RI SI-17 "Self-insurance Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035658/form-ri-si-17-self-insurance-agreement-rhode-island.png "Form RI SI-17 "Self-insurance Agreement" - Rhode Island")
![Form RI SI-7A "Trust Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035648/form-ri-si-7a-trust-agreement-rhode-island.png "Form RI SI-7A "Trust Agreement" - Rhode Island")
![Form RI SI-7B "Certificate of Deposit Agreement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035652/form-ri-si-7b-certificate-of-deposit-agreement-rhode-island.png "Form RI SI-7B "Certificate of Deposit Agreement" - Rhode Island")
![Form RI SI-10 "Indemnity Agreement by the Parent Corporation for Wholly Owned Subsidiary or if Applicable Partially Owned or Controlled Affiliate" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035651/form-ri-si-10-indemnity-agreement-by-the-parent-corporation-for-wholly-owned-subsidiary-or-if-applicable-partially-owned-or-controlled-affiliate-rhode-island.png "Form RI SI-10 "Indemnity Agreement by the Parent Corporation for Wholly Owned Subsidiary or if Applicable Partially Owned or Controlled Affiliate" - Rhode Island")
![Form RI SI-5C "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035649/form-ri-si-5c-bond-of-employer-authorized-to-pay-workers-compensation-benefits-directly-to-employees-or-their-dependents-rhode-island.png "Form RI SI-5C "Bond of Employer Authorized to Pay Workers' Compensation Benefits Directly to Employees or Their Dependents" - Rhode Island")
![Form DWC-03S "Seasonal Wage Statement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1904/19045/1904585/form-dwc-03s-seasonal-wage-statement-rhode-island.png "Form DWC-03S "Seasonal Wage Statement" - Rhode Island")
![Form DWC-03P "Part-Time Wage Statement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1904/19045/1904584/form-dwc-03p-part-time-wage-statement-rhode-island.png "Form DWC-03P "Part-Time Wage Statement" - Rhode Island")
![Form DWC-03F "Full-Time Wage Statement" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1904/19045/1904582/form-dwc-03f-full-time-wage-statement-rhode-island.png "Form DWC-03F "Full-Time Wage Statement" - Rhode Island")
![Form RI SI-17B "Self-insurance Agreement Continuation, Extension and/Or Amendment" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035656/form-ri-si-17b-self-insurance-agreement-continuation-extension-and-or-amendment-rhode-island.png "Form RI SI-17B "Self-insurance Agreement Continuation, Extension and/Or Amendment" - Rhode Island")
![Form DWC-11-C "Election by Exempt Corporate Officer to Become Subject to Workers' Compensation" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1905/19054/1905420/form-dwc-11-c-election-by-exempt-corporate-officer-to-become-subject-to-workers-compensation-rhode-island.png "Form DWC-11-C "Election by Exempt Corporate Officer to Become Subject to Workers' Compensation" - Rhode Island")
![Form DWC-11-R "Rescind Notice of Claim of Common Law Rights" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1905/19054/1905419/form-dwc-11-r-rescind-notice-claim-common-law-rights-rhode-island.png "Form DWC-11-R "Rescind Notice of Claim of Common Law Rights" - Rhode Island")
![Form DWC-11-IC "Notice of Designation as Independent Contractor Pursuant to Rigl 28-29-17.1" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1728/17283/1728342/form-dwc-11-ic-notice-designation-as-independent-contractor-pursuant-to-rigl-28-29-17-1-rhode-island.png "Form DWC-11-IC "Notice of Designation as Independent Contractor Pursuant to Rigl 28-29-17.1" - Rhode Island")
![Form DWC-11-ICR "Notice of Withdrawal of Designation as Independent Contractor Pursuant to Rigl 28-29-17.1" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035633/form-dwc-11-icr-notice-of-withdrawal-of-designation-as-independent-contractor-pursuant-to-rigl-28-29-17-1-rhode-island.png "Form DWC-11-ICR "Notice of Withdrawal of Designation as Independent Contractor Pursuant to Rigl 28-29-17.1" - Rhode Island")
!["Application Request for Employee BI-Weekly Pay" - Rhode Island](https://data.templateroller.com/pdf_docs_html/1906/19062/1906217/application-request-for-employee-bi-weekly-pay-rhode-island.png ""Application Request for Employee BI-Weekly Pay" - Rhode Island")
!["Non-payment of Wages Complaint Form" - Rhode Island](https://data.templateroller.com/pdf_docs_html/2035/20356/2035631/non-payment-of-wages-complaint-form-rhode-island.png ""Non-payment of Wages Complaint Form" - Rhode Island")
