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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.
DOL Form 28A Notice of Change in Compensation Rate (For Injuries Before July 1, 1986) - Vermont
What Is DOL Form 28A?
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.
FAQ
Q: What is DOL Form 28A?
A: DOL Form 28A is the Notice of Change in Compensation Rate for injuries that occurred 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 any changes in compensation rates for injuries that occurred before July 1, 1986 in Vermont.
Q: Who needs to fill out DOL Form 28A?
A: Employers or insurance carriers are responsible for filling out DOL Form 28A in Vermont for injuries that occurred before July 1, 1986.
Form Details:
- Released on June 1, 2022;
- The latest edition provided by the Vermont Department of Labor;
- 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 DOL Form 28A by clicking the link below or browse more documents and templates provided by the Vermont Department of Labor.
