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 64 State Forms found

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General Release of Medical/Health Care Information

 WCB-220 (eff 09/04/2023, rev 10/23/2023)

EMPLOYMENT STATUS REPORT

 WCB-230 (eff. 1/1/13)

EMPLOYEE'S RETURN TO WORK REPORT

 WCB-231 (eff. 1/1/13)

EMPLOYEE'S RETURN TO WORK REPORT

WCB-231A (eff. 1/1/13)

NOTICE OF INTENT TO APPEAL

 WCB-240 (eff. 9/1/18)

REQUEST FOR EXPEDITED PROCEEDING

 WCB-250 (eff. 1/1/13, rev. 12/4/2023)

APPLICATION FOR PREDETERMINATION OF INDEPENDENT CONTRACTOR STATUS TO ESTABLISH CONCLUSIVE PRESUMPTION

 WCB-260 (eff. 1/1/13, rev. 5/8/19)

APPLICATION FOR A CERTIFICATE OF INDEPENDENT STATUS

 WCB-262 (eff. 1/1/13, rev. 5/8/19)

DISCONTINUED BY STATE, REPLACED WITH ID 9919 - APPLICATION FOR PREDETERMINATION OF INDEPENDENT CONTRACTOR STATUS TO ESTABLISH A REBUTTABLE PRESUMPTION

WCB-266 - DEACTIVATED (eff. 8/01/2013)

COMPLAINT FOR AUDIT

 WCB-282 (eff. 1/1/13, rev. 2/25/19)

APPLICATION FOR EVALUATION EMPLOYMENT REHABILITATION SERVICES PURSUANT TO 39-A M.R.S.A. 217(1)

 WCB-320 (eff 3/5/2020, rev 10/11/2023)

DISCONTINUED BY STATE, REPLACED WITH ID 3458 - PETITION TO DETERMINE ENTITLEMENT TO REHABILITATION SERVICES PURSUANT TO 39-A M.R.S.A. §217(2)

 WCB-321 - DEACTIVATED (eff. 1/1/13)

APPLICATION FOR WAGE CREDIT EMPLOYMENT REHABILITATION FUND

 WCB-322 (eff. 1/1/13)

STATE AVERAGE WEEKLY WAGE NOTICE

 SAWW/MAX Rev. 5/23/24

DIAGNOSTIC MEDICAL REPORT

 M-1 (Effective 09/04/2023)
Disclaimer: These forms may not be the most recent version. Maine 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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