Oregon Forms
21 State Forms found
| name | number | revision | print or send online | |
|---|---|---|---|---|
Insurer's Report |
440-1502 | 4/20 | ||
Endorsement to Include Legal Entity in Self-Insured Certification |
440-1865 | 8/23 | ||
Form 4821: Oregon Proof of Coverage EDI Insurer Profile |
440-4821 | 3/24 | ||
Insurer Notice of Closure Summary |
440-1503 | 5/24 | ||
Notice of Closure Worksheet (Dates of injury on or after Jan. 1, 2005) |
440-2807a | 05/24 | ||
Notice of Closure Worksheet (Dates of injury prior to Jan. 1, 2005) - Insurer |
440-2807 | 05/24 | ||
Insurer Request for Reconsideration |
440-2223b | 1/24 | ||
Notice of Closure |
440-1644 | 5/24 | ||
Notice of Voluntary Reopening Own Motion Claim |
440-3501 | 2/16 | ||
Worker Leasing Termination Notice (Cancels a client's proof of coverage) |
440-3271 | 8/18 | ||
Worker Request for Reconsideration |
440-2223a | 1/24 | ||
Self-Insured Employer Report of Losses Experience Rating Period |
440-2809 | 1/25 | ||
INDEMNITY AGREEMENT BY THE PARENT COMPANY FOR SUBSIDIARIES |
440-4966 | 9/17 | ||
Insurer's notification of business in Oregon |
440-1352 | 3/24 | ||
Application for Self-Insurance |
440-1868 | 8/23 | ||
Disclaimer: These forms may not be the most recent version. Oregon 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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