Publications and Forms

Affidavit for Security Release - Group Trusts (WC-264-G)

A sample affidavit for former self-insured group trusts requesting release of security.

 
Application for Authority to Self-Insure (WC-81)

The application to be completed by an employer applying to individually self-insure.

 
Application for Consultation Service Form (LS-25)

An application for a Missouri On-Site Safety and Health Consultation. Fill out an application online here.

 
Application for Group Self-Insurance (WC-81A)

The application to be completed by a group of employers applying to form a self-insured group trust.

 
Auditing Procedures for Applicants for Individual Self-Insurance (WC-130-AI)

The safety auditing procedures for those employers applying to individually self-insure.

 
Authorization for Release of Confidential Information (WC-249-3)

An authorization for release of confidential information that must accompany the Irrevocable Letter of Credit (WC-249).

 
Bond of Employer Carrying His Own Risk (WC-82B)

A Surety Bond; one of three options available to meet the self-insurance security requirement.

 
Checklist for Individual Self-Insurance Applications (WC-128)

The checklist of required items and information that must accompany the Application for Authority to Self-Insure (WC-81).

 
Child Labor Complaint Form (LS-53)
A form to submit a complaint about child labor.
 
Classifying Employees for Unemployment Insurance Tax Purposes (MODES-INF-310)

Information for employers regarding classifying employees for unemployment insurance tax purposes.