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Forms

General QER Instructions

Insurance Company Initial and Annual Claims Report (Fillable PDF)

Expenditure Report (ServiceNow)

Quarterly Expenditure Report Form

Quarterly Expenditure Report Form (Word)

Surcharge Remittal Form FY 25 (Form is for FY2025, effective July 1, 2024)

Other Forms

Physician's Referral to Domiciliary Care

Subsequent Injury Fund Application

Employment Verification Form Information - Montana Employees in North Dakota

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    • Self Insurance
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    • Workers' Compensation Surcharges
  • Insurance Compliance
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  • Forms
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Department of Labor & Industry

Employment Standards Division

Mailing Address

P.O. Box 8011
Helena, MT 59604

Phone

(406) 444-6543

Physical Address

301 South Park Avenue
Floors 4 and 5
Helena, MT 59601

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Contact Information

Phone: (406) 444-6543

Mailing Address

P.O. Box 8011
Helena, MT 59604

Physical Address

301 South Park Avenue
Floors 4 and 5
Helena, MT 59601

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