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Vermont Forms

79 State Forms found

name	number	revision	print or send online
EMPLOYER’S NOTICE OF INTENTION TO DISCONTINUE PAYMENTS	DOL Form 27	Rev. 5/18
Employer’s Liability and Workers’ Compensation NOTICE TO EMPLOYEES	Form 31 WC-10	(12/05)
REPORT OF BENEFITS AND RELATED EXPENSES PAID	DOL FORM 13	(Rev. 9/09)
REPORT OF FATAL ACCIDENT	DOL Form 4	Rev 9/11
SELF-INSURER’S REPORT	No Form Number	REVISED 2/2017
COMPROMISE AGREEMENT	DOL Form 16	(Rev. 7/14)
Denial/Discontinuance of Vocational Rehabilitation by Employer or Carrier	DOL FORM VR227	Rev. 8/11
WAGE STATEMENT – For injuries occurring on or after July 1, 2008	DOL FORM 25	(Rev. 5/2025)
WEEKLY NET INCOME WORKSHEET	DOL Form 25s	(Rev. 9/09)
Work Capabilities Form	Form 20	Rev. 12/10
Application to Exclude Corporate Officers or LLC Members From Workers' Compensation Coverage	Form 29	Rev. 11/22
2016 NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES AFTER JULY 1, 1986)	DOL Form 28	Rev 6/15
2016 NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES BEFORE JULY 1, 1986)	DOL Form 28A	Rev 6/15
CHILD LABOR CERTIFICATE	WH-27	7/08
Unemployment Insurance Business Registration	C-1	(1/25)

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