Minnesota Department of Labor and Industry Forms

This form is used for submitting a report on rehabilitation consultations in Minnesota. It is available in Spanish.

This form is used for submitting a notice of closure for a rehabilitation plan in the state of Minnesota.

This document outlines the rights and responsibilities of an injured worker in Minnesota regarding rehabilitation. It is used for understanding the entitlements and obligations of injured workers during the rehabilitation process.

This form is used for requesting an extension in the state of Minnesota.

This form is used for reporting work ability in the state of Minnesota. It is used to assess an individual's ability to perform job-related tasks and determine their eligibility for certain benefits or accommodations.

This form is used for submitting a rehabilitation response in the state of Minnesota.

This Form is used for submitting a rehabilitation request in the state of Minnesota.

This form is used for attorneys in Minnesota who need to request certification of a dispute.

This form is used for creating a retraining plan in the state of Minnesota. It helps individuals outline their goals and strategies for acquiring new skills and finding employment.

This Form is used for authorizing the review or release of copies of a workers' compensation claim file in Minnesota.

This document is a model contract between a patient and a healthcare provider in Minnesota for long-term treatment with opioid medication. It outlines the terms and conditions of the treatment, including the responsibilities of both parties. This contract helps ensure a clear and legally binding agreement between the patient and provider.

This Form is used for adding benefits in the state of Minnesota.

This Form is used for conducting a Functional Capacity Evaluation (FCE) in the state of Minnesota. It helps assess an individual's physical ability to perform specific tasks and determine their level of functional capacity.

This form is used for reporting attorney fees and costs in the state of Minnesota.

This form is used for submitting a notice of penalty payment in the state of Minnesota.

This document is for completing checklists for the internship completion of a Qualified Rehabilitation Consultant (QRC) in Minnesota.

This form is used for conducting on-site analysis of occupational hazards in Minnesota. It helps identify potential risks and develop strategies to ensure a safe work environment.

This form is used for lodging complaints against rehabilitation providers in Minnesota.

This form is used for submitting a notice to close a file in the state of Minnesota. It is typically used in legal, administrative, or governmental settings.

This document is an invoice used for Vocational Rehabilitation services provided in the state of Minnesota. The invoice is used to request payment for services rendered.

This document is a request for the assignment of rates in the state of Minnesota. It is used to determine the appropriate rates for a particular service or product in accordance with state regulations and guidelines.

This form is used for self-insured companies in Minnesota to report their outstanding losses. It helps the state track and monitor the financial standing of these companies.

This form is used for reporting and tracking employee benefits in the state of Minnesota.

This form is used for reporting the purchase of investments and fixed assets in the state of Minnesota.

This Form is used for reporting investments in Minnesota.

This form is used for reporting other assets in the state of Minnesota.

This form is used for notifying an insurer of their primary liability determination in Minnesota.

This form is used for requesting a formal hearing in the state of Minnesota.

This form is used to provide additional information or make changes to an annual claim for reimbursement of supplementary benefits in Minnesota.

This form is used for objecting to penalty assessments in Minnesota.

This document is for requesting a penalty in Minnesota for failure to pay or deny a rehabilitation invoice.

This form is used for reporting elevator incidents in the state of Minnesota. It is used to document any incidents or accidents that occur in an elevator, such as malfunctions or injuries.

This Form is used for reporting complaints about elevators in the state of Minnesota.

This form is used for employees in Minnesota who are requesting an administrative conference regarding the discontinuance of their workers' compensation benefits. It allows employees to assert their rights and seek resolution on the matter.

This document is used by employers in Minnesota to provide formal notice to employees. It contains important information regarding changes in employment policies, schedules, or other relevant matters.