Skip to Content

Workers' Compensation Board

Language Assistance: (877) 632-4996 | Language Access Policy

Board Assessments

50-5 Annual Private Self-Insured Assessment

These forms require Adobe Reader to render the form.   The latest version of Adobe Reader® Link to External Website is available as a free download from Adobe's web site.

The Board anticipates the GA-5 Annual Private Self-Insured Remittance Form will be available April 2019.

Questions may be sent to: