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Massachusetts Forms

18 State Forms found

name	number	revision	print or send online
AFFIDAVIT IN SUPPORT OF REQUEST FOR WAIVER OF FILING FEE UNDER SEC. 11C	Form 112A	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 UNDER SECTION 37 or 37A	Form 123	Revised 7/2024
APPEAL OF CONFERENCE PROCEEDING	Form 121	Revised 7/2019
EMPLOYEE’S HEARING MEMORANDUM	Form 161	Revised 7/2019
INSURER’S HEARING MEMORANDUM	Form 162	Revised 3/2024
LIEN DISCLOSURE FORM	Form 116C	Revised 4/2024
NOTICE OF CHANGE / APPEARANCE OF COUNSEL	Form 114	Revised 7/2019
REQUEST FOR SECTION 37 OR 37A PROCEEDING	Form 122	Revised 7/2024
CONFERENCE MEMORANDUM	Form 140	Revised 7/2019
THIRD PARTY CLAIM / NOTICE OF LIEN	Form 115	Revised 7/2019
VERIFICATION OF MASSACHUSETTS WORKERS’ COMPENSATION COVERAGE FOR OUT OF STATE EMPLOYERS OPERATING IN MASSACHUSETTS	Form 154	Amended 7/2019
SECTION 19A MEDICAL MEDIATION AGREEMENT	Form 19-A	Updated:1/28/2022
IFB Referral Form	No Form Number	No Form/Rev Date

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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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