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Master Agreement

The DPA has released a copy of the Interagency Agreement between the DPA and State Fund for the period of July 1, 2004, through June 30, 2009. This document, commonly referred to as the "Master Agreement" is your guide and can be downloaded in either Microsoft Word or Adobe PDF document format.*  

    Form #
  Master Agreement [1 MB]  
     
  The following are links to attachments of the Master Agreement  
     
  Notice to Employer of Investigation [52 K]  
  Delay in Decision Check Off Worksheet [40 K]  
  Finalization Worksheet [68 K]  
  Employee's Claim for Workers' Compensation Benefits (English/Spanish) [84 K] 3301e
  Sample - Departmental Claim Tracking Worksheet [52 K]  
  "Side Letter" Agreement [96 K]  

*You will need Adobe's Acrobat Reader to view and print State Fund PDF forms and documents. Click on the image to the right to download the latest reader free of charge from Adobe Systems.

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