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Form Accounting ICA6623 Notice of Self-insurer's Termination of Self-insurance Form - Arizona
What Is Form Accounting ICA6623?
This is a legal form that was released by the Industrial Commission of Arizona - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of the Form Accounting ICA6623?A: The Form Accounting ICA6623 is used to notify the termination of self-insurance by a self-insurer in Arizona.
Q: Who should fill out the Form Accounting ICA6623?A: The self-insurer who is terminating their self-insurance in Arizona should fill out this form.
Q: What information is required on the Form Accounting ICA6623?A: The form requires basic information about the self-insurer and the effective date of the termination.
Q: Is there a deadline for submitting the Form Accounting ICA6623?A: Yes, the form must be submitted to the Arizona Industrial Commission within 30 days of the effective date of termination.
Form Details:
- Released on October 15, 2017;
- The latest edition provided by the Industrial Commission of Arizona;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form Accounting ICA6623 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Industrial Commission of Arizona.
Download Form Accounting ICA6623 Notice of Self-insurer's Termination of Self-insurance Form - Arizona
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