State Form 12386 Self-insured Employer Certification - Indiana

What Is State Form 12386?

This is a legal form that was released by the Indiana Workers' Compensation Board - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 12386?
A: Form 12386 is the Self-insured Employer Certification form.

Q: Who should use Form 12386?
A: This form should be used by self-insured employers in Indiana.

Q: What is the purpose of Form 12386?
A: The purpose of this form is to certify that an employer is self-insured in Indiana.

Q: Are all employers required to complete Form 12386?
A: No, only self-insured employers need to complete this form.

Q: What information is required on Form 12386?
A: The form requires the employer's name, address, contact information, and self-insurance information.

Q: Is there a fee for filing Form 12386?
A: No, there is no fee for filing this form.

Q: When should Form 12386 be filed?
A: Form 12386 should be filed upon initial certification as a self-insured employer and annually thereafter.