Form No Sample Clauses

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: 30,000 Estimated Annual Reporting and Recordkeeping Cost Burden: $0.

Form No. 1: NOTIFICATION OF INTENTION TO AWARD‌ This Notification of Intention to Award shall be sent to each Tenderer that submitted a Tender. Send this Notification to the Tenderer's Authorized Representative named in the Tender Information Form on the format below.

Form No. 1: Hourly Litigation

Form No. 9A—original notice and petition and order for partial commutation. This form contains the same data and requirements as Form No. 9. However, all remaining benefits are not com- muted. No language of release is contained.

Form No. 9—original notice and petition and order for commutation of all remaining benefits of ten weeks or more 876 IAC 6.2(6). 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 xxxxx- xxxx. The form contains language of release.

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. PART 1.0: APPLICANT’S PARTICULARS.