Form Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form - Arizona

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form Accounting ICA6613 for the current year.

Form Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form - Arizona

What Is Form Accounting ICA6613?

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 Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form?
A: The purpose of this form is to gather information from self-insured employers in Arizona regarding their annual hospital report.

Q: Who needs to fill out the Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form?
A: Self-insured employers in Arizona are required to fill out this form.

Q: What information is required in the Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form?
A: The form asks for information about the employer's self-insured status, total hospital claims paid during the year, and number of employees covered.

Q: How often does the Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form need to be submitted?
A: This form needs to be submitted annually.

ADVERTISEMENT

Form Details:

  • Released on December 5, 2019;
  • 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 ICA6613 by clicking the link below or browse more documents and templates provided by the Industrial Commission of Arizona.

Download Form Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form - Arizona

4.5 of 5 (29 votes)
  • Form Accounting ICA6613 Self-insured Employer - Annual Hospital Report Form - Arizona, Page 1
ADVERTISEMENT