Industrial Commission of Arizona Forms

This form is used for filing a minimum wage claim in Arizona. It is intended for labor disputes related to wages and ensures that employees receive the legally mandated minimum wage.

This form is used for carriers in Arizona to refer individuals for vocational rehabilitation services.

This Form is used for filing a Petition for Attorney's Fees in Arizona under a.r.s. 23-1069.

This Form is used for reporting a worker's injury in Arizona. It requires information from both the worker and the physician involved.

This Form is used for filing a supplemental claim for workers in Arizona. It provides additional documentation for workers' compensation claims.

This form is used for the apportionment settlement letter in Arizona for SpecFunds ICA5527.

This form is used for filing a claim to recover unpaid wages in the state of Arizona.

This document is for requesting alternative service and waiving a specific rule in Arizona.

This document is used to file a claim for unpaid wages in the state of Arizona. If you have not been paid for work you have done, you can use this form to seek compensation.

This form is used to file a claim for earned paid sick time in Arizona.

This document is used for filing a claim related to minimum wage violations in the state of Arizona.

This form is used for self-insured employers in Arizona to report quarterly taxes related to their employees.

This Form is used for accounting purposes by insurance carriers to file quarterly tax information in the state of Arizona.

This Form is used for notifying the Arizona Industrial Commission about the installation, relocation, or significant alteration of elevators, escalators, dumbwaiters, or other similar equipment.

This Form is used for requesting certificate inspection of the installation or reinstallation of a boiler or fired pressure vessel in Arizona.

This form is used for filing a claim for unpaid wages in the state of Arizona.

This form is used for reporting complaints related to youth labor issues in Arizona.

This document is used for filing a minimum wage claim in the state of Arizona. It allows individuals to request compensation for wages that have not been paid in accordance with state minimum wage laws.

This form is used for claiming earned paid sick time in the state of Arizona.

This Form is used for filing a retaliation claim related to minimum wage in Arizona.

This Form is used for filing a payment compliance complaint in Arizona.

This form is used for filing a complaint against an employer in Arizona who does not have workers' compensation insurance coverage. It allows employees to report any injury or illness suffered at work and seek compensation for medical expenses and lost wages.

This Form is used for filing a complaint against an employer in Arizona who does not have workers' compensation insurance.

This form is used for reporting self-insured injuries in the state of Arizona. It provides a way for individuals to document and report any injuries they have sustained while under a self-insured insurance plan.

This form is used for applying for an alternate clearance in the state of Arizona.