Request for Investigation Pursuant to A.R.S. § 23-1061(J) Form
… This form may be used by an injured worker to request … Hearing Form - Information about the Industrial Commission of Arizona’s claims and hearing …
SHARP Application Form
… new SHARP candidates to fill out an application form. The form is used to provide the ADOSH … Consultation Team will reach out to schedule a visit to discuss your site and develop a plan …
Claims Notice of Intent to Suspend Form
… If a completed Workers’ Annual Report of Income form (Form 110-A) is not returned by the …
Resources for the 2025 ICA Claims Seminar
… from our recent seminar in one convenient place for you. Here you can download presentations for your records and also purchase the 2025 ICA …
Customer Service Representative 2
… Industrial Commission Of Arizona Customer Services … the ICA’s Human Resources Department at (602) 542-5559. … Customer Service Representative 2 …
Forms
… If necessary, please download Adobe Reader Visit Website Static forms need to be printed … manually. Interactive forms may be opened online or downloaded to your PC and completed at …
Accounting Self-Provider of Medical Benefits Form Instructions
… employer currently authorized by the Industrial Commission of Arizona to self-insure its … St, Room 301, Phoenix AZ 85007 Phone: (602) 542-1839 FAX: (602) 542-3070 … Accounting …
Claims - About Vocational Rehabilitation
… Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: (520) 628-5181 FAX (use for either office): (602) 542-3373 Phone List …
Motion to Appoint Guardian Ad Litem for an Incapacitated Adult (1982)
… Use this motion form if a claimant or a beneficiary is an … a Guardian Ad Litem (GAL) must be appointed for such persons. Additionally, the law requires …
Divisions
… ICA Community Is Now Live Join the ICA Community Now! Visit Website Resources for the ICA Community …