Current through Register Vol. 30, No. 50, December 13, 2024
Section R20-5-1503 - Forms and Reports The following forms, available at http://www.azica.gov and upon request from the Division, shall be used when applicable:
1. Initial Application for Authority to Self-Insure Form,2. Self-Insurance Renewal Application Form,3. New Pool Member Application Form,4. Workers' Compensation Liability Form,5. Application to Self-Administer Form,6. Self-Provider of Medical Benefits Form,8. Workers' Compensation Guaranty Bond Form,9. Statutory Deposit Agreement Form,10. Custody Agreement Form,11. Request for Waiver of Security Form,12. Notice of Termination of Self-Insurance Form,13. Annual Payroll Report Form,14. Annual Medical Report Form,15. Annual Injury Report Form,16. Annual Hospital Report Form,17. Quarterly Tax Payment Form.Ariz. Admin. Code § R20-5-1503
New section made by final rulemaking at 28 A.A.R. 3435, effective 10/5/2022.