State of New Hampshire Forms in Word

New Hampshire Worker’s Compensation Forms in Word

Form No. Form Type and Title Price Buy Now

8aWCA Notice of Accidental Injury or Occupational Disease& $12.99
8WC Employer’s First Report of Occupational Injury or Disease Form $12.99
8WC Employer’s First Report of Occupational Injury or Disease Form& $12.99
9 WCA Memo of Payment of Disability Compensation& $12.99
76 WCA 1-94 Wage Schedule& $12.99
76 WCA1 Supplemental Wage Schedule& $12.99
13 WCA 7-89 Employer’s Supplemental Report of Injury $12.99
9 WCA-1 9-02 Memo of Denial of Workers’ Compensation Benefits& $12.99
75 WCA-1 6-94 NH Workers’ Compensation Medical Forms& $12.99
10 WCA 10/98 Memo of Permanent Impairment Award& $12.99
74 WCA 7-89 Report of Extended Disability& $12.99
  NH Workers’ Compensation Task Analysis& $12.99
15 WCA 10-99 Lump Sum Settlement Forms& $12.99
WC-3PR-1 7-89 Release and Settlement of Claim& $12.99
  Authorization for Compensation for Death& $12.99
  Authorization to Permit Witness at Medical Examination& $12.99
53WC Employee’s Statement of Employment Status& $12.99
53-A Notice to Suspend Payment of Workers’ Compensation Benefits& $12.99
Self Insurance      
  Self-Insurance Application& $12.99
  Self-Insurance Questionnaire& $12.99
  Self-Insurance Surety Bond& $12.99
  Certificate of Insurance& $12.99
  Endorsement& $12.99
  Annual Financial Statement& $12.99
  General Purpose Rider& $12.99
  Guarantee Proposal& $12.99
  Outstanding Liabilities& $12.99
  Parent Company Agreement& $12.99
  Securities Deposit Agreement& $12.99
  Securities Deposit Agreement Past Liability& $12.99
Second Injury Fund      
  Application for Second Injury Fund& $12.99
  Request for Reimbursement from the Second Injury Fund& $12.99
  Schedule of Reimbursable Payments& $12.99
  Second Injury Fund Affidavit of Employer Knowledge& $12.99
  Second Injury Fund Certification by Physician& $12.99
  Application for Reimbursement of Paid Adjusted Total Disability& $12.99
  Application for Reimbursement of Paid Combined Earnings& $12.99
Third Party Administrators      
  Security Deposit Agreement for Third Party Administrator& $12.99
  Application for Certificate of Authority& $12.99
  Notice of Contract Between Third Party Administrator and Self Insurer& $12.99
  Third Party Administration Bond& $12.99
  Biographical Affidavit& $12.99
Job Modification      
  Request for Job Modification Plan Approval& $12.99
Vocational Rehabilitation      
  NH Vocational Rehabilitation Provider Certification Form& $12.99
IWRP Individual Written Rehabilitation Plan& $12.99
  Vocational Rehabilitation Training Agreement& $12.99
  Rehabilitation Closure Form& $12.99
  Rehabilitation Referral Form& $12.99
DES 605 New Hampshire New Hire Reporting Form $12.99