Form No. 3: CONTINGENCY FEE
1. Conditions (Par. 1) and Effective Date (Par. 19)
Form No. N/A. Estimated Annual Burden: 28 respondents; 89 responses; .017 hours (1 minute) to 50 hours per response; 934 burden hours per year; $0 annual cost burden.
Form No. 1 (survey);
Form No. N/A. Respondents: Business or other for- profit. Estimated Annual Burden: 11 Estimated Annual Reporting and Recordkeeping Cost Burden: $0.
Form No. 0:APPLICANT’S PARTICULARS. 1.1. Name: ……………………………………………..……………………………..ID No: …………………………………Date of Birth: ………….………………
Form No. 9—application for commutation of all remaining benefits. This form contains data relevant to benefits paid and those to be paid by commutation when all unaccrued benefits are due. Signatures of the parties are necessary. Approval by the workers’ compensation commissioner or a deputy commissioner is necessary. The form contains language of release.
Form No. 9A—application for partial commutation. This form contains the same data and requirements as Form No. 9. However, all remaining benefits are not commuted. No language of re- lease is contained.
Form No. N/A. Respondents: Business or other for- profit. Estimated Annual Burden: 15
Form No. PART 1.0: APPLICANT’S PARTICULARS.
Form No. 1: Hourly Litigation
