Michigan Department of Labor and Economic Opportunity Forms

This Form is used for notifying seasonal workers in Michigan about their employment status.

This form is used for in-state institutions in Michigan to apply for and obtain approval to participate in the SARA (State Authorization Reciprocity Agreements) program.

This form is used for obtaining authorization from the state of Michigan to offer distance education programs to residents of the state by out-of-state institutions.

This Form is used for completing a liability questionnaire in the state of Michigan. It helps individuals or businesses gather information regarding their liabilities for tax purposes.

This form is used for updating client level information for the PEO program in the state of Michigan. It is necessary for maintaining accurate records and compliance with program requirements.

This document is used to provide notice to workers in Michigan about reasonable work safety for the upcoming season. Please note that this form is in Spanish.

This Form is used for reporting and documenting income tax withholding for residents of Michigan.

This form is used for filing an application for mediation or hearing in Michigan.

This form is used for applying for reimbursement from the Medical Benefits Fund in Michigan. It allows individuals to seek reimbursement for medical expenses incurred.

This form is used to apply for an advance payment in the state of Michigan.

This form is used for recording and charting amputations in Michigan. It helps to keep track of amputation cases for legal and medical purposes.

This form is used for carrier's explanation of benefits in Michigan.

This form is used for applying for certification of a carrier's professional healthcare review program in Michigan.

This Form is used for insurers to notify Michigan authorities of any changes in their name or address.

This document is used for filing an employee's claim report in Michigan.

This document is a form used in Michigan for the redemption of a demand.

This Form is used for healthcare providers to request a reconsideration of a denied claim in the state of Michigan.

This Form is used for filing a claim or cross-claim for review in Michigan. It is used to initiate a legal process for review of a decision made by an administrative agency or court.

This form is used for redeeming abandoned property in Michigan. It allows individuals or organizations to request the release of their abandoned property held by the state.

This form is used for issuing a subpoena in Michigan to obtain records or compel a witness to testify in a legal proceeding.

This form is used for claiming a redemption from multiple insurance carriers in Michigan.

This form is used for an agreement in the state of Michigan to redeem liability for the WC-556.

This form is used for authorizing the disclosure of confidential workers' compensation information in Michigan.

This form is used as an addendum to an agreement to redeem liability in the state of Michigan. It provides additional details or modifications to the original agreement.

This form is used for applying for workers' disability compensation as a group self-insurer in Michigan.

This form is used for self-insured employers in Michigan to request the addition or deletion of a subsidiary or affiliate to their coverage.

This Form is used for applying as a workers' compensation agency service company in Michigan.

This form is used for self-insured groups in Michigan to provide a notice of acceptance of membership.

This document is a type of surety bond specific to Michigan. It is used to provide continuous coverage for certain business activities in the state.

This form is used for self-insured groups in Michigan to notify the termination of membership.

This Form is used for transferring claims between self-insurers in the state of Michigan.