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Massachusetts Forms

15 State Forms found

name	number	revision	print or send online
ADDENDUM TO LUMP SUM SETTLEMENT AGREEMENT - VOCATIONAL REHABILITATION STATUS	FORM 116B	Revised 10/2023
AFFIDAVIT OF EMPLOYEE IN APPLICATION FOR TRUST FUND BENEFITS	Form 170	7/2019
AFFIDAVIT OF INDIGENCE AND REQUEST FOR WAIVER OF 11A(2) FEES	Form 136	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 TO EXTEND 180 DAY PAYMENT WITHOUT PREJUDICE PERIOD	Form 105	Revised 7/2019
AGREEMENT TO PAY COMPENSATION	Form 113	Revised 7/2019
AVERAGE WEEKLY WAGE COMPUTATION SCHEDULE	Form 127	Revised 7/2019
EMPLOYEE’S EARNING REPORT	Form 126	Revised 7/2019
CONSENT OF EMPLOYER TO LUMP SUM SETTLEMENT	Form 116A	Revised 7/2019
INSURER’S NOTIFICATION OF ACCEPTANCE, RESUMPTION OR TERMINATION OR MODIFICATION OF WEEKLY COMPENSATION	Form 107	Revised 7/2019
INSURER’S NOTIFICATION OF PAYMENT	Form 103	Revised 5/11/2020
Workers’ Compensation Trust Fund Mileage Voucher	No Form Number	Undated Form
NOTIFICATION OF ARBITRATION AWARD	Form 124A	Revised 7/2019
NOTIFICATION OF WITHDRAWAL OF CLAIM OR COMPLAINT	Form 109	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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