SFO Jimmy's Patronis' Seal

Forms for Governmental Self-Insured Employers


A Governmental Self-Insured Employer is required by law to provide important information to the Division annually. The Division has developed rules and adopted prescribed forms for self-insurers to use for reporting required information to the Division. A summary of relevant statutes, rules and forms are below. Please use the forms below for reporting required information to the Division.

Required Forms:

Premium Related Forms: