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Vermont Forms

18 State Forms found

name	number	revision	print or send online
AGGREGATE Annual Reporting Form – Reporting Period 7-01 – 6-30	DOL FORM 13-A	(Rev. 8/16)
AGREEMENT FOR TEMPORARY COMPENSATION	Form 32	(Rev. 6/23)
MEMORANDUM OF PAYMENT	Form 25M	Rev. 1/15
EMPLOYER’S NOTICE OF INTENTION TO DISCONTINUE PAYMENTS	DOL Form 27	Rev. 5/18
REPORT OF BENEFITS AND RELATED EXPENSES PAID	DOL FORM 13	(Rev. 9/09)
WAGE STATEMENT – For injuries occurring on or after July 1, 2008	DOL FORM 25	(Rev. 1/2018)
WEEKLY NET INCOME WORKSHEET	DOL Form 25s	(Rev. 9/09)
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
Mileage Reimbursement Request	No Form Number	No Form/Rev Date
2020 NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES AFTER JULY 1, 1986)	DOL FORM 28	Rev 6/19
2020 NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES BEFORE JULY 1, 1986)	DOL FORM 28A	Rev 6/19
2021 NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES AFTER JULY 1, 1986)	DOL FORM 28	Rev 6/20
2021 NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES BEFORE JULY 1, 1986)	DOL FORM 28A	Rev 6/20
MINIMUM AND MAXIMUM COMPENSATION RATES: ANNUAL CHANGE / HISTORICAL RATES	No Form Number	No Form/Rev Date

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