This version of the form is not currently in use and is provided for reference only. Download this version of DOL Form 28A for the current year.
This is a legal form that was released by the Vermont Department of Labor - a government authority operating within Vermont. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is DOL Form 28A?
A: DOL Form 28A is the Notice of Change in Compensation Rate form.
Q: Who should use DOL Form 28A?
A: DOL Form 28A should be used by individuals who experienced injuries before July 1, 1986 in Vermont.
Q: What is the purpose of DOL Form 28A?
A: The purpose of DOL Form 28A is to notify the Department of Labor about changes in the compensation rate for injuries that occurred before July 1, 1986.
Q: Is DOL Form 28A specific to Vermont?
A: Yes, DOL Form 28A is specific to injuries that occurred in Vermont before July 1, 1986.
Form Details:
Download a fillable version of DOL Form 28A by clicking the link below or browse more documents and templates provided by the Vermont Department of Labor.