S.C. Code Regs. 67-203. Official Forms and Documents

A. The Commission prepares and approves all required forms. A person shall use a Commission form and shall not substitute another document for a form. Reproduction of a form the same size is permitted, provided content is not altered. B. Commission forms are available on the web site. The Commission supplies at a reasonable charge, upon written request to the Commission’s Mail Room, the following forms. (1) Form S-1, Notice of Third Party Action, Employer; (2) Form S-2, Notice of Third Party Action, Employee; (3) Form S-3, Entitlement to Right of Action; (4) Form S-4, Court Certificate; (5) Form 2, Employer’s Notice of Being Subject to the Act; (6) Form 5, Corporate Officer Notice to Reject; (7) Form 6, Application to Create a Self-Insurance Fund; (8) Form 6A, Application for Membership in a Self-Insurance Fund; (9) Form 7, Application to Individually Self-Insure; (10) Form 7A, Corporate Guaranty; (11) Form 8, Proof of Compliance, Surety Bond; (12) Form 8A, Proof of Compliance, Securities Pledge; (13) Form 8B, Proof of Compliance, Memorandum of Understanding, and Irrevocable Letter of Credit; (14) Form 8C, Proof of Compliance, Excess Insurance; (15) Form 9, Certificate for Self-Insurance; (16) Form 10, Self Insurance Tax Return; (17) Form 11, Self Insurer’s Quarterly Financial Report; (18) Form 11A, Self Insurer’s Annual Financial Report; (19) Form 12A, Employer’s First Report of Injury (ACORD 4); (20) Form 12M, Annual Minor Medical Report; (21) Form 14A, Health Insurance Claim Form (HCFA-1500); (22) Form 14B, Physician’s Statement; (23) Form 15, Temporary Compensation Report; (24) Form 15S, Supplemental Report of Varying Temporary Partial Payments; (25) Form 16, Agreement for Permanent Disability/Disfigurement Compensation (prior to July 1, 2007); (26) Form 16A, Agreement for Permanent Disability/Disfigurement Compensation (after July 1, 2007); (27) Form 17, Receipt of Compensation; (28) Form 18, Periodic Report; (29) Form 19, Status Report and Compensation Receipt; (30) Form 20, Statement of Earnings of Injured Employee; (31) Form 21, Employer’s Request for Hearing; (32) Form 24, Application for Lump Sum Award; (33) Form 27, Subpoena; (34) Form 30, Request for Commission Review; (35) Form 31, Notice of Review Hearing; (36) Form 32, Request to Waive Appeal Filing Fee; (37) Form 36, Medical Fee Approval; (38) Form 38, Employer’s Withdrawal of Election to Adopt the South Carolina Workers’ Compensation Act; (39) Form 39, Coverage Coding Form; (40) Form 50, Employee’s Notice of Claim and/or Request for Hearing; (41) Form 51, Employer’s Answer to Request for Hearing; (42) Form 52, Employee’s Notice of Claim and/or Request for Hearing, Death Case; (43) Form 53, Employer’s Answer to Request for Hearing, Death Case; (44) Form 54, Employer’s Notice of Claim and/or Request for Hearing; (45) Form 55, Second Injury Fund’s Answer to Employer’s Request for Hearing; (46) Form 58, Pre-hearing Brief; (47) Form 59, Appellant’s Informal Brief; (48) Form 61, Attorney Fee Petition; (49) Form 65, Waiver of Claim Involving an Occupational Disease; (50) Second Injury Fund Form 1, Agreement to Reimburse Compensation; (51) Second Injury Fund Form 2, Reimbursement Request; (52) Second Injury Fund Form 3, Employer’s Notice of Claim for Reimbursement from Second Injury Fund; (53) Second Injury Fund Form 4, Medical Information Request.