Self-Insurance Annual Tax Forms

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

TO ACCESS FORMS OR INSTRUCTIONS, CLICK ON A LINK BELOW.

• 2015 Self-Insured Annual Tax Forms
   
  • 2015 Annual Letter (PDF)
  • 2015 Hospital Report Form (Excel)
  • 2015 Hospital Report Instructions (PDF)
  • 2015 Injury Report Form (Excel)
  • 2015 Injury Report Instructions (PDF)
  • 2015 Medical Report Form (Excel) (Instructions are included on form for 2015.)
  • 2015 Payroll Report Form (Excel)
  • 2015 Payroll Report Instructions (PDF)

• 2014 Self-Insured Annual Tax Forms
   
  • 2014 Annual Letter (PDF)
  • 2014 Hospital Report Form (Excel)
  • 2014 Hospital Report Instructions (PDF)
  • 2014 Injury Report Form (Excel)
  • 2014 Injury Report Instructions (PDF)
  • 2014 Medical Report Form (Excel) (Instructions are included on form for 2014.)
  • 2014 Payroll Report Form (Excel)
  • 2014 Payroll Report Instructions (PDF)

• 2013 Self-Insured Annual Tax Forms
   
  • 2013 Annual Letter (PDF)
  • 2013 Hospital Report Form (Excel)
  • 2013 Hospital Report Instructions (PDF)
  • 2013 Injury Report Form (Excel)
  • 2013 Injury Report Instructions (PDF)
  • 2013 Medical Report Form (Excel) (Instructions are included on form for 2013.)
  • 2013 Payroll Report Form (Excel)
  • 2013 Payroll Report Instructions (PDF)

• 2012 Self-Insured Annual Tax Forms
   
  • 2012 Annual Letter (PDF)
  • 2012 Hospital Report Form (Excel)
  • 2012 Hospital Report Instructions (PDF)
  • 2012 Injury Report Form (Excel)
  • 2012 Injury Report Instructions (PDF)
  • 2012 Medical Report Form (Excel) (Instructions are included on form for 2012.)
  • 2012 Payroll Report Form (Excel)
  • 2012 Payroll Report Instructions (PDF)

• 2011 Self-Insured Annual Tax Forms
   
  • 2011 Annual Letter (PDF)
  • 2011 Hospital Report Form (PDF)
  • 2011 Hospital Report Instructions (PDF)
  • 2011 Injury Report Form (PDF)
  • 2011 Injury Report Instructions (PDF)
  • 2011 Medical Report Form (PDF) (Instructions are included on form for 2011.)
  • 2011 Payroll Report Form (PDF)
  • 2011 Payroll Report Instructions (PDF)

• 2010 Self-Insured Annual Tax Forms
   
  • 2010 Annual Letter (PDF)
  • 2010 Hospital Report Form (PDF)
  • 2010 Hospital Report Instructions (PDF)
  • 2010 Injury Report Form (PDF)
  • 2010 Injury Report Instructions (PDF)
  • 2010 Medical Report Form (PDF)
  • 2010 Medical Report Instructions (PDF)
  • 2010 Payroll Report Form (PDF)
  • 2010 Payroll Report Instructions (PDF)

• 2009 Self-Insured Annual Tax Forms
   
  • 2009 Annual Letter (PDF)
  • 2009 Hospital Report Form (PDF)
  • 2009 Hospital Report Instructions (PDF)
  • 2009 Injury Report Form (PDF)
  • 2009 Injury Report Instructions (PDF)
  • 2009 Medical Report Form (PDF)
  • 2009 Medical Report Instructions (PDF)
  • 2009 Payroll Report Form (PDF)
  • 2009 Payroll Report Instructions (PDF)