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QER

Work Comp Regulations Forms

Construction Contractor Forms and Applications

Construction Contractor's Cover Letter (pdf)

Construction Contractor's Registration Application (pdf)

Independent Contractor Forms and Applications

Independent Contractor Exemption Certificate Application for Sole Proprietor, Partnership or LLP, Member-Managed LLC's and Construction Industry Manager-Managed LLC's (Letter-Sized paper) (pdf)

Independent Contractor Exemption Certificate Application for Sole Proprietor, Partnership or LLP, Member-Managed LLC's and Construction Industry Manager-Managed LLC's (Legal-Sized paper) (pdf)

Independent Contractor Exemption Certificate Application for Corporate Officers and Non-Construction Industry Manager-Managed LLC's (Letter-Sized paper) (pdf)

Independent Contractor Exemption Certificate Application for Corporate Officers and Non-Construction Industry Manager-Managed LLC's (Legal-Sized paper) (pdf)

Visit the ICCU home page for more information on the Independent Contractor Exemption Certificate Process.

Insurance Compliance / Quarterly Expenditure Reports

General QER Instructions (pdf)

QER Form (pdf)

Surcharge Remittal Form (quarter ending 09-30-2012) (pdf)

Other Forms

Physician's Referral to Domiciliary Care (word)

Hospital Rate Change Form

Subsequent Injury Fund Application (pdf)

Memorandum of Agreement - Sample (pdf)

MT.gov