PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
DOL Form 28
for the current year.
DOL Form 28 Notice of Change in Compensation Rate (For Injuries After July 1, 1986) - Vermont
What Is DOL Form 28?
This is a legal form that was released by the Vermont Department of Labor - a government authority operating within Vermont. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DOL Form 28?A: DOL Form 28 is the Notice of Change in Compensation Rate for injuries after July 1, 1986.
Q: What is the purpose of DOL Form 28?A: DOL Form 28 is used to report any changes in the compensation rate for injuries that occurred after July 1, 1986.
Q: Who needs to fill out DOL Form 28?A: The employer or their insurance carrier needs to fill out DOL Form 28.
Q: When should DOL Form 28 be submitted?A: DOL Form 28 should be submitted as soon as there is a change in the compensation rate.
Form Details:
- Released on June 1, 2022;
- The latest edition provided by the Vermont Department of Labor;
- 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 DOL Form 28 by clicking the link below or browse more documents and templates provided by the Vermont Department of Labor.
