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Reminder: CMS-1500 electronic submission is mandatory

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Web Submission of Claim Forms List of Available Forms for Attorneys and Licensed Representatives

These forms are available for completion and online submission through the Board's website.

After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. It should be saved for your records. DO NOT MAIL THIS FORM TO THE BOARD.

Form Instructions

Forms submitted by attorneys and licensed representatives
Form Number Form Title Registration required? Comments
PH-16.2 Pre-Hearing Conference Statement No Filed ten days before scheduled pre-hearing conference for controverted cases (FROI-04/SROI-04).
VDF-1 Loss of Wage Earning Capacity Vocational Data Form No Injured Workers who may have a non-schedule permanent impairment and who have not returned to work are encouraged to complete and submit Form VDF-1 as early as possible in the claim.

If the form you are looking for is not available for online submission, you may print the PAPER version of the form from our list of common forms.

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