Get the free DOL Form 13 (Rev - labor vermont
Show details
DOL FORM 13-A (Rev. 5/05) Reporter s Fed. I'd No. Fiscal Year Department of Labor Workers Compensation Division PO Box 488 Montpelier, VT 05601-0488 www.labor.vermont.gov AGGREGATE Annual Reporting
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign dol form 13 rev
Edit your dol form 13 rev form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your dol form 13 rev form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit dol form 13 rev online
Follow the guidelines below to use a professional PDF editor:
1
Check your account. In case you're new, it's time to start your free trial.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit dol form 13 rev. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
Dealing with documents is simple using pdfFiller.
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
How to fill out dol form 13 rev
How to fill out dol form 13 rev:
01
Begin by entering your personal information in Section A. This includes your full name, address, and contact details.
02
Move on to Section B and provide information about your employer. Fill in the name of your employer, their address, and any other requested details.
03
In Section C, you need to provide information about your claim. This includes the type of benefit being claimed, the date of injury or illness, and the date you last received payment from your employer.
04
If you have any dependents, fill out Section D accordingly. Provide the names, birth dates, and relationship of each dependent.
05
Section E requires you to list any other sources of income you are receiving while making the claim, such as workers' compensation or disability benefits.
06
In Section F, provide details of any prior claims you have made related to the same injury or illness. Include the dates and outcomes of these claims.
07
Move on to Section G and describe in detail the circumstances leading to your injury or illness. Be as specific as possible, including dates, locations, and any witnesses.
08
If you have received any medical treatment, indicate it in Section H. Provide the names of the healthcare providers, the dates of treatment, and a brief description of the services received.
09
In Section I, you may need to provide additional information or comments related to your claim. Use this section to explain anything that you believe is important or relevant.
10
Finally, sign and date the form in Section J, certifying that all the information provided is true and accurate to the best of your knowledge.
Who needs dol form 13 rev:
01
Employees who have suffered a work-related injury or illness and wish to file a claim for compensation.
02
Employers who need to gather information about an employee's injury or illness to process the claim and comply with legal requirements.
03
Insurance companies or third-party administrators involved in handling workers' compensation claims may also require the form to assess the validity of the claim.
Fill
form
: Try Risk Free
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
What is dol form 13 rev?
DOL Form 13 Rev is a form used by employers to report changes in their employees' identifying information to the Department of Labor.
Who is required to file dol form 13 rev?
Employers are required to file DOL Form 13 Rev when there are changes in their employees' identifying information.
How to fill out dol form 13 rev?
To fill out DOL Form 13 Rev, employers need to provide their employer identification number (EIN), the employees' correct information, and the reason for the change.
What is the purpose of dol form 13 rev?
The purpose of DOL Form 13 Rev is to ensure that the Department of Labor has accurate information about employees for their records.
What information must be reported on dol form 13 rev?
Employers must report changes in employees' names, social security numbers, and addresses on DOL Form 13 Rev.
How can I manage my dol form 13 rev directly from Gmail?
Using pdfFiller's Gmail add-on, you can edit, fill out, and sign your dol form 13 rev and other papers directly in your email. You may get it through Google Workspace Marketplace. Make better use of your time by handling your papers and eSignatures.
How do I make edits in dol form 13 rev without leaving Chrome?
Install the pdfFiller Google Chrome Extension to edit dol form 13 rev and other documents straight from Google search results. When reading documents in Chrome, you may edit them. Create fillable PDFs and update existing PDFs using pdfFiller.
How do I edit dol form 13 rev on an Android device?
With the pdfFiller mobile app for Android, you may make modifications to PDF files such as dol form 13 rev. Documents may be edited, signed, and sent directly from your mobile device. Install the app and you'll be able to manage your documents from anywhere.
Fill out your dol form 13 rev online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
Dol Form 13 Rev is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
