| AC-2 |
Request to Add/Change or Terminate Permanent Authorization |
Print PDF |
Submit online |
| AC-3 |
Request Temporary Authorization |
Print PDF |
Submit online |
| CHP-4A |
Application For Disability Relief |
Print PDF |
Submit online |
| LEGAL-15 |
Application for Adjudication Hearing |
Print PDF |
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| R-1 |
Employer Authorized Representative |
Print PDF |
Submit online |
| R-4 |
Application for Representative Identification Number |
Print PDF |
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| SH-26 |
Safety Management Self-Assessment |
Print PDF |
Submit online |
| SI-6 |
Initial Application by Employer for Authority to Pay Compensation Etc. Directly |
Print PDF |
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| SI-16 |
Agreement Between Employer and the Ohio Bureau of Workers' Compensation Regarding Amount of Self-Insured Buyout |
Print PDF |
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| SI-38 |
Contract of Guaranty |
Print PDF |
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| SI-44 |
Election to Withdraw from Claims Reimbursement Fund |
Print PDF |
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| U-149 |
Sponsor Certification Application |
Print PDF |
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