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Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

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Insurance Carrier Annual Tax Forms

Administrative Support Division
Self-Insurance Section
Phone: (602) 542-1839

 

 

To Access Forms or Instructions, Click on a Link Below.

 

2015 Insurance Carrier Annual Tax Forms

2015 Insurance Carrier Annual Letter (PDF)

Read more about Insurance Carrier Annual Tax Forms

Carriers Authorized to Write WC Ins in Az

 

Phone List of ICA Divisions

Click here

Carriers Authorized to Write Workers' Comp Insurance in Arizona

Read more about Carriers Authorized to Write WC Ins in Az

Self-Insurance and Tax Office

Accounting Division - Self-Insurance and Tax Office

Phone List of ICA Divisions

Click here

View Insurance Carrier and Self-insurance Tax Forms

Click here

View Self-insurance Program Forms

Read more about Self-Insurance and Tax Office

Nonfatal Incident Rates

Read more about Nonfatal Incident Rates

Nonfatal Case Characteristics Incident Rates

Read more about Nonfatal Case Characteristics Incident Rates

Nonfatal Case Characteristics Counts

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Nonfatal 2016 Counts

Read more about Nonfatal 2016 Counts

Fatal Injury Graphs (Set II)

Read more about Fatal Injury Graphs (Set II)

Fatal Injury Graphs (Set I)

Read more about Fatal Injury Graphs (Set I)

Fatal Injury Data (Tables A-1 thru A-9)

Read more about Fatal Injury Data (Tables A-1 thru A-9)

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Contact

Phoenix Office
800 W. Washington Street
Phoenix, AZ 85007

 

Tucson Office
2675 E. Broadway Blvd
Tucson AZ 85716

 

Phoenix: (602) 542-4661
Tucson: (520) 628-5188

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