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Massachusetts Forms

72 State Forms found

name	number	revision	print or send online
EMPLOYEE’S CLAIM	Form 110	Revised 7/2019
EMPLOYEE BIOGRAPHICAL DATA	Form 160	Revised 7/2019
Employer's First Report of Injury, Illness or Death	Form 101	Rev 4/2014
ADDENDUM TO LUMP SUM SETTLEMENT AGREEMENT - VOCATIONAL REHABILITATION STATUS	FORM 116B	Revised 10/2023
AFFIDAVIT IN SUPPORT OF EMPLOYEE’S REQUEST FOR SPEEDY CONFERENCE BECAUSE OF HARDSHIP	Form 132	Revised 7/2019
AFFIDAVIT IN SUPPORT OF REQUEST FOR WAIVER OF FILING FEE UNDER SEC. 11C	Form 112A	Revised 7/2019
AFFIDAVIT OF EMPLOYEE IN APPLICATION FOR TRUST FUND BENEFITS	Form 170	7/2019
AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS	Form 153	Revised 11-05-2021
AFFIDAVIT OF INDIGENCE AND REQUEST FOR WAIVER OF 11A(2) FEES	Form 136	Revised 7/2019
Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers	No Form Number	Revised 7-2019
Workers’ Compensation Insurance Affidavit: General Businesses	No Form Number	Form Revised 7/2019
AGREEMENT FOR REDEEMING LIABILITY BY LUMP SUM UNDER G.L. CH. 152, SEC. 48 FOR INJURIES OCCURRING BEFORE NOV. 1, 1986	Form 117A	Revised 7/2019
AGREEMENT FOR REDEEMING LIABILITY BY LUMP SUM UNDER G.L. CH. 152 FOR INJURIES OCCURRING ON OR AFTER NOV. 1, 1986	Form 117	Revised 7/2019
AGREEMENT THAT NO IMPARTIAL PHYSICIAN REPORT IS REQUIRED	Form 121A	Revised 7/2019
AGREEMENT TO EXTEND 180 DAY PAYMENT WITHOUT PREJUDICE PERIOD	Form 105	Revised 7/2019

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