New Hampshire Department of Labor Forms

This Form is used for filing a complaint as a whistleblower in the state of New Hampshire.

This Form is used for the Wage Schedule of Workers' Compensation in New Hampshire.

This form is used for establishing a parent company agreement in the state of New Hampshire. It outlines the terms and conditions agreed upon between a parent company and its subsidiaries.

This form is used for a securities deposit agreement in New Hampshire. It outlines the terms and conditions for the deposit of securities.

This form is used for providing a summary of actuarial opinions in the state of New Hampshire.

This Form is used for requesting reimbursement from the Second Injury Fund in New Hampshire.

This form is used for reporting reimbursable payments in the state of New Hampshire.

This form is used for employers in New Hampshire to provide an affidavit of their knowledge about the Second Injury Fund.

This Form is used for physicians to certify a second injury under the Second Injury Fund in the state of New Hampshire.

This document is for applying to get reimbursed for paid adjusted total disability benefits from the Special Fund for Active Cases in New Hampshire.

This form is used for applying to be reimbursed for combined earnings differential from the Special Fund for Second Injuries in New Hampshire.

This form is used for creating a security deposit agreement between a third-party administrator and the state of New Hampshire. It outlines the terms and conditions for the security deposit.

This document is a bond required for third-party administrators operating in New Hampshire. It protects individuals and organizations who contract with the administrator by ensuring financial compensation for any losses caused by negligence or misconduct.

This type of document is used for creating an individualized rehabilitation plan for individuals in the state of New Hampshire.

This document outlines an agreement between an individual in New Hampshire and a vocational rehabilitation program. It details the training and support provided to help the individual regain or develop skills necessary for employment.

This document is used for referring individuals in New Hampshire to vocational rehabilitation services.

This form is used for reporting accidental injuries or occupational diseases in the state of New Hampshire.

This document is used for recording and documenting the payment of disability compensation in New Hampshire under Workers' Compensation Act.

This form is used for employers in New Hampshire to report additional information regarding a work-related injury.

This document is used for filing a workers' compensation medical form in the state of New Hampshire.

This form is used for submitting a memo of permanent impairment award in New Hampshire for workers' compensation cases.

This form is used for reporting extended disability in New Hampshire.

This form is used for completing a workers' compensation task analysis in New Hampshire. It helps to determine the tasks involved in a worker's job and assess the potential risks for compensation purposes.

This form is used for authorizing compensation for death in New Hampshire workers' compensation cases. It is required to properly file a claim for this type of compensation.

This form is used for employees in New Hampshire to provide a statement about their employment status.

This form is used for notifying the intention to suspend payment of workers' compensation benefits in New Hampshire.

This document is for the initial application for employee leasing in the state of New Hampshire.

This form is used for renewing the lease of an employee in the state of New Hampshire.

This document is a surety bond that is specifically designed for employee leasing companies in the state of New Hampshire. It serves as a guarantee that the company will fulfill its obligations and responsibilities in relation to its leased employees.

This form is used for applying for workers' compensation self-insurance as a group in the state of New Hampshire.

This form is used for completing a self insurance questionnaire specific to the state of New Hampshire. It is required for individuals or entities seeking to self-insure in the state.

This form is used for obtaining a self-insurance surety bond in the state of New Hampshire. It is required for businesses or organizations that wish to self-insure their liabilities instead of purchasing insurance from a traditional insurer. The bond provides financial protection in the event that the self-insuring entity fails to meet its obligations.

This form is used for obtaining a Certificate of Insurance in the state of New Hampshire. It provides proof of insurance coverage for a person or business.

This form is used for adding additional provisions or making changes to an insurance policy in the state of New Hampshire.

This type of document is an Appendix II Safety Summary Form specific to the state of New Hampshire. It likely contains information related to safety protocols and procedures.

This document provides instructions for completing the Appendix II Safety Summary Form in the state of New Hampshire. It outlines the required information and guidelines for ensuring compliance with safety regulations.

This form is used for an employee to request a waiver to a day of rest in the state of New Hampshire.

This Form is used for requesting to waive the lunch or eating period in the state of New Hampshire.