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.
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.
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.
Form Details:
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.