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Virginia Forms

82 State Forms found

name	number	revision	print or send online
Claim Summary Addendum for 2026 Annual Survey	No Form Number	(Rev. 10/1/23)
First Report of Injury	VWC Form #3	Rev. 10/08
Annual Payroll Report of City, Town or County Operating as a Self-Insurer	FORM 26C	7/6/2011
Annual Report of Self-Insurer's Payroll	Form 26	4/10/12
Annual Report of Self-Insurer's Payroll by City, Town or County School Boards	Form 26B	7/6/2011
Employer's Application for Individual Self-Insurance Under the Virginia Workers' Compensation Act	VWC Form No. SI20	(rev. 11/6/17)
Award Agreement	Form #CSD-50	Rev. 02/2026
Cost-of-Living Adjustment (COLA) Request	CA51	Rev. 7/25
Employer's Application for Hearing	VWC Form No. 5A	Rev. 1/26
Expedited Hearing Request - EDI	No Form Number	Rev. 11/21
Fatal Award Agreement	VWC Form #35	Rev. 11/21
Irrevocable Letter of Credit - Packet	VWC Form No. SI21-B	(11/14/17)
(DISCONTINUED BY STATE, NO REPLACEMENT) Letter to Sheriff	No Form Number - DEACTIVATED	Undated Form
PARENTAL GUARANTEE	VWC Form No. SI22	(rev. 08/1/15)
Petition Under the Virginia Birth-Related Neurological Injury Compensation Act, Pursuant to Virginia Code § 38.2-5004	VWC Form No. BR1	REV 7/18/05

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Disclaimer: These forms may not be the most recent version. Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.

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