PDF
Word
Form Accounting ICA6623 Notice of Self-insurer's Termination of Self-insurance Form - Arizona
What Is Form Accounting ICA6623?
This is a legal form that was released by the Industrial Commission of Arizona - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of the Form Accounting ICA6623?
A: The Form Accounting ICA6623 is used to notify the termination of self-insurance by a self-insurer in Arizona.
Q: Who should fill out the Form Accounting ICA6623?
A: The self-insurer who is terminating their self-insurance in Arizona should fill out this form.
Q: What information is required on the Form Accounting ICA6623?
A: The form requires basic information about the self-insurer and the effective date of the termination.
Q: Is there a deadline for submitting the Form Accounting ICA6623?
A: Yes, the form must be submitted to the Arizona Industrial Commission within 30 days of the effective date of termination.
Form Details:
- Released on October 15, 2017;
- The latest edition provided by the Industrial Commission of Arizona;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form Accounting ICA6623 by clicking the link below or browse more documents and templates provided by the Industrial Commission of Arizona.
Download Form Accounting ICA6623 Notice of Self-insurer's Termination of Self-insurance Form - Arizona
1
2
