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Connecticut Forms

58 State Forms found

name	number	revision	print or send online
WEEKLY BENEFITS TABLES FOR OCTOBER 1, 2025 - SEPTEMBER 30, 2026	No Form Number	Oct 1, 2025-Sept 30, 2026
Employer's First Report of Occupational Injury or Illness	FRI	Rev. 7-13-2009
Notice of Claim for Compensation (Employee to Administrative Law Judge and to Employer)	30C	Rev. 06-14-2024
Physician's Permanent Impairment Evaluation	42	Rev. 11-3-2023
AUTHORIZATION TO OBTAIN AND/OR DISCLOSE HEALTH INFORMATION	No Form Number	Revised October 1, 2025
COMMUTATION AND WHAT IT MEANS	No Form Number	Rev. 08-19-2022
Coverage Election by Employee who is an Officer of a Corporation or a Member of an LLC	6B	Rev. 10-2-2025
Coverage Election by Employees Who are Members of a Partnership	6B-1	Rev. 10-2-2025
Coverage Election by Sole Proprietor	75	Rev. 10-2-2025
Dependent’s Notice of Claim (To Administrative Law Judge and to Employer)	30D	Rev. 06-14-2024
Employee Medical & Work Status Form	No Form Number	Rev. 9-26-2011
Implementation of Safety & Health Connecticut Administrative Regulations 31-40v-1 through 31-40v-11	No Form Number	Last revised March 25, 1998
INFORMATION ON SELF-INSURANCE/APPLICATION FOR CERTIFICATE OF SELF-INSURANCE	No Form Number	Rev. 03/01/22
Filing Status and Exemption	1A	Rev. 7-13-2009
Building Permit Requirements for Workers’ Compensation	7A-7B-7C DIRECTIONS	Rev. 3-17-2006

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Disclaimer: These forms may not be the most recent version. Connecticut 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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