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 65 State Forms found

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MEMORANDUM OF ONE-TIME PAYMENT

 WCB-3A (Effective 6-1-2026)

EMPLOYER’S FIRST REPORT OF OCCUPATIONAL INJURY OR DISEASE

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

REQUEST FOR INDEPENDENT MEDICAL EXAMINATION

 WCB M-2 (eff. 1/1/13, rev. 10/15/15)

WAGE STATEMENT

 WCB-2 (Effective 6-1-2026)

SCHEDULE OF DEPENDENT(S) AND FILING STATUS STATEMENT

 WCB-2A (effective 09/27/2023)

FRINGE BENEFITS WORKSHEET

 WCB-2B (Effective 6-1-2026)

APPLICATION FOR WAIVER

 WCB-2C (eff. 1/1/13)

MEMORANDUM OF PAYMENT

 WCB-3 (Effective 6-1-2026)

MODIFICATION OF COMPENSATION

 WCB-4M (Effective 6-1-2026)

CONSENT BETWEEN EMPLOYER AND EMPLOYEE

 WCB-4A (eff. 9/1/20, rev. 12/4/23)

CERTIFICATE AUTHORIZING RELEASE OF BENEFIT INFORMATION

 WCB-6 (effective 9/1/2020)

CERTIFICATE AUTHORIZING RELEASE OF UNEMPLOYMENT INFORMATION

 WCB-7 (eff. 9/1/2020, rev. 10/9/2025)

CERTIFICATE OF DISCONTINUANCE OR REDUCTION OF COMPENSATION

 WCB-8 (Effective 6-1-2026)

NOTICE OF CONTROVERSY

 WCB-9 (eff. 9/1/2020, rev. 12/4/2023)

LUMP SUM SETTLEMENT

 WCB-10 (Effective 6-1-2026)
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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