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OhioBWC - Employer - Form:  Application for Permanent Authorization

Permanent Authorization (AC-2)


This form allows an employer or employer representative to authorize access to a company's policy and/or claim(s) based on the type of representation requested.
Note: There must be a hard copy of the AC-2 on site at the employer's before you can submit the form here online. This authorization will supersede all permanent authorizations on file for the representative type chosen.

Required information
  • Policy number OR Federal tax ID/SSN
  • Authorized representative ID/Name
  • Authorized representative type
  • Name of person who completed hard copy AC-2
  • Title of person who completed hard copy AC-2
  • Actual date of completed hard copy AC-2

Complete the forms

The free Adobe Reader software is required to display and print the application.

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Are you missing some of the required information? If so, you may return here at a later time when you have all the information you need, and complete this online form.