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Arkansas Form Center -

Type & Print Forms - programmed for direct type and print functionality.

Each form may be downloaded in Adobe Acrobat format. Download the form by clicking on the form number below.
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Form

Description

form1.pdf First Report of Injury or Illness
form1_RD.pdf Form 1 Required Data.
form2.pdf Employer Intent to Accept or Controvert Claim
form2_RD.pdf Form 2 Required Data
form3.pdf Physician's Report
form4.pdf Report of Compensation Paid/Suspension Report
form4_RD.pdf Form 4 Required Data
forma.pdf Application for Certificate of Non Coverage
forma_s.pdf Application for Certificate of Non-Coverage Required Notary Statement
formc.pdf Claim for Compensation
formcsp.pdf Claim for Compensation (Spanish)
formd.pdf Death and Permanent Total Disability Acceptance/Update
formd_RD.pdf Form D Required Data
formh.pdf POSTER - Health Notice for Managed Care
forml.pdf Lump Sum Request/Respondent's Position
formm.pdf Monthly Medical-Only Injury Data
formn.pdf Notice to Employer/Notice to Employee
formn-sp.pdf Notice to Employer/Notice to Employee (Spanish)
formo.pdf Claim Office / Medical Billing / Administrator / Underwriter Designation Form
formp.pdf POSTER - Poster of Instructions
formp-sp.pdf POSTER - Poster of Instructions (Spanish)
formr.pdf Report of Mediation Conference
forms.pdf Supplemental Report
formv.pdf Verification of Permanent-Total Disability
formw.pdf Wage Statement
formhs-31a.pdf Application for Approved Professional Safety Source (APSS) and/or Field Safety Representative (FSR)
formhs-31c.pdf Accident Prevention Services Annual Report
formhs-31d.pdf Accident Prevention Services Worksheet
formhs-31-e.pdf List of FSR/APSS
formhs-32a.pdf Hazard Survey Report
formhs-32b.pdf Health and Safety Plan Cover Sheet
formhs-32-c.pdf Notification of Potential Error
formhs-36a.pdf Voluntary Drug-Free Workplace Program Application
formhs-36b.pdf Voluntary Drug-Free Workplace Program Annual Insurance Carrier Report
formsi-1.pdf Individual Self-Insurer Application
formsi-11.pdf Group Self-Insurance Application
formsi-12.pdf Application for Membership in a Group
formsi-tpa.pdf Third-Party Administrator Application / Registration
mileage.pdf Medical Mileage Worksheet
medrelease.pdf Authorization for Release of Medical Records
faq.pdf BROCHURE - Arkansas Workers' Compensation Questions & Answers