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Kentucky Forms

97 State Forms found

name	number	revision	print or send online
Application for Resolution of a Claim - Injury	No Form Number	February 2020 Edition
First Report of Injury or Illness - EDI Submission Only	FORM IA-1	(r 1-1-02)
MOTION TO REOPEN KRS 342.732 BENEFITS	MTR-2	July 2002 Edition
AFFIDAVIT OF EXEMPTION FROM THE KENTUCKY WORKERS’ COMPENSATION ACT (CORPORATION OR PARTNERSHIP)	No Form Number	Adopted 1/1/97
AFFIDAVIT OF EXEMPTION FROM THE KENTUCKY WORKERS’ COMPENSATION ACT (INDIVIDUAL)	No Form Number	Adopted 1/1/97
AGREEMENT AS TO COMPENSATION AND ORDER APPROVING SETTLEMENT	FORM 110-F	October 2016 Edition
AGREEMENT AS TO COMPENSATION AND ORDER APPROVING SETTLEMENT	FORM 110-I	Revised February 2020
Application for Resolution of Coal Workers' Pneumoconiosis Claim- Online Submission Only	FORM 102-CWP	Revised 6/05
Application for Resolution of a Claim – Hearing Loss	No Form Number	February 2020 Edition
Application for Resolution of a Claim – Occupational Disease	No Form Number	February 2020 Edition
Drug and Alcohol Free Workplace Policy	No Form Number	No Form/Rev Date
WAGE CERTIFICATION	Form AWW-1	Adopted January 1, 1997
CONTINUOUS BOND	Form SI-03	Rev. 01/04
Workers' Compensation Statistical Report	Form 150	No Form/Rev Date
ELECTRONIC PARTNERING AGREEMENT	No Form Number	2003

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Disclaimer: These forms may not be the most recent version. Kentucky 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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