PURPOSE: This rule sets forth the forms required for filing with the division by the employee, employer and insurer. Included are instructions to obtain forms.

Forms required for filing with the division are listed in this rule, together with a few other forms required of employees, employers and insurers. Under the provisions of section 287.630, RSMo, these forms are provided free of charge. Those requiring such forms should send their requests to the division at Jefferson City, giving the form serial number and the quantity needed. Some forms, such as subpoenas and Forms 42 and 43, which have to be executed separately for individual cases, cannot, of course, be sent out in quantities. The only cost in connection with procuring the forms is transportation charges.

Form No.

2-A

9-A

25-A

65-B

82 (Bond) 82 (Escrow)

AUTHORITY: section 287.650, RSMo 1986.* Original rule filed Aug. 26, 1975, effective Sept. 5, 1975.

*Original authority: 287.650, RSMo 1939, amended 1949, 1961, 1980, 1993, 1995, 1998. 8 CSR 50-5 Use Report of Injury Receipt and Notice of Termination of Compensation Receipt for Compensation Notice of Commencement of Compensation Notice of Termination of Compensation Request for Lump Sum Settlement Surgeon’s Report Physician’s Report on Eye Injuries Claim for Compensation Answer to Claim for Compensation Subpoena Subpoena Duces Tecum Special Order for Additional Medical Authorization to Inspect and/or Copy Medical Records Withdrawal of Employer’s Acceptance of Law Memorandum of Insurance Coverage Application for Authority to Self-Insure Bond of Self-Insurer Escrow Agreement of Self- Insurer Self-Insurer’s Statement of Outstanding Disability Claims Self-Insurer’s Payroll Report Self-Insurer’s Annual Financial Statement Self-Insurer’s Report of Compensation Payments