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 22 State Forms found

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ABATEMENT FORM

 No Form Number No Form/Rev Date

NOTICE OF ACCEPTANCE OF THE "TENNESSEE WORKERS' COMPENSATION ACT" BY AN EXEMPTED EMPLOYER

 FORM I-8 / LB-0014 (REV. 5/18)

DRUG FREE WORKPLACE PROGRAM APPLICATION

 LB-1111 (REV 10/21)

WORKERS’ COMPENSATION STATISTICAL DATA FORM

 FORM SD1 / LB-0904 (REV. 06-16)

JOB ORDER TRANSMITTAL

 LB-0610 R. 12/03

NOTICE OF WITHDRAWAL OF AN EXEMPT EMPLOYERS’ VOLUNTARY ELECTION

 FORM I-9 / LB-0289 (REV 11/15)

AFFIDAVIT OF INDIGENCY

 LB-1108 (REV 11/15)

AFFIDAVIT OF INDIGENCY (Spanish)

 LB-1108s (REV 11/15)

NOTICE OF ACCEPTANCE OF THE "TENNESSEE WORKERS' COMPENSATION ACT" BY AN EXEMPTED EMPLOYER (Spanish)

 FORMULARIO I-8 / LB-0014s (REV. 4/18)

NOTICE OF WITHDRAWAL OF AN EXEMPT EMPLOYERS’ VOLUNTARY ELECTION (Spanish)

 FORMULARIO I-9 / LB-0289s (REV 11/15)

DISPUTE CERTIFICATION NOTICE (Spanish)

 LB-1096 / RDA 10183 Rev. 3/16

CERTIFICATE OF NON-REPRESENTATION (CNR)

 LB-3252 /RDA-10183 08-2017

CERTIFICATE OF NON-REPRESENTATION (CNR) (Spanish)

 LB-3252 / RDA-10183 08-2017

NOTICE OF APPEAL RIGHTS FOR A UTILIZATION REVIEW DENIAL (Spanish)

 LB-1023s / FORMULARIO C-35A (REV 12/16)

MEDICAL IMPAIRMENT RATING (MIR) MEDICAL WAIVER AND CONSENT (Spanish)

LB-0929s Se modificó en 9/16
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