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Form LS-275(IC) Agreement and Undertaking (Insurance Carrier)
What Is Form LS-275(IC)?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on April 1, 2010 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is form LS-275(IC)?
A: Form LS-275(IC) is an Agreement and Undertaking for Insurance Carriers.
Q: Who needs to complete form LS-275(IC)?
A: Insurance carriers need to complete form LS-275(IC).
Q: Why is form LS-275(IC) required?
A: Form LS-275(IC) is required to establish an agreement between the insurance carrier and the relevant authority.
Form Details:
- Released on April 1, 2010;
- The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form LS-275(IC) by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.
Download Form LS-275(IC) Agreement and Undertaking (Insurance Carrier)
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