This version of the form is not currently in use and is provided for reference only. Download this version of DOL Form 28 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 28?
A: DOL Form 28 is the Notice of Change in Compensation Rate for injuries after July 1, 1986.
Q: What is the purpose of DOL Form 28?
A: DOL Form 28 is used to report any changes in the compensation rate for injuries that occurred after July 1, 1986.
Q: Who needs to fill out DOL Form 28?
A: The employer or their insurance carrier needs to fill out DOL Form 28.
Q: When should DOL Form 28 be submitted?
A: DOL Form 28 should be submitted as soon as there is a change in the compensation rate.
Form Details:
Download a fillable version of DOL Form 28 by clicking the link below or browse more documents and templates provided by the Vermont Department of Labor.