INSTRUCTIONS: ALABAMA ASSESSMENT REPORT FOR INSURANCE COMPANIES, SELF-INSURERS AND GROUP FUNDS (WCC Form 10)   

Alabama insurance companies, group funds and self-insured businesses must file a WCC Form 10 on an annual basis. This form can be obtained from the website of the Alabama Department of Labor.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 1: Enter your company name.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 2: Enter the name of a contact person.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 3: Enter your mailing and physical address.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 4: Enter your NCCI, FEIN, SI and GSI numbers.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 5: Enter your telephone number.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 6: Enter any subsidiaries if you are a self-insured company.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 7: Enter your total compensation paid.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 8: Enter your total medical costs paid.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 9: Enter your total attorney fees paid.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 10: Enter your total administrative expenses paid.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 11: Enter your total court settlements paid.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 12: Enter the total of all these expenses.  

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 13: Print your name where indicated.   

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 14: The bottom of the form must be completed in the presence of a notary public. Print your name again and enter your corporate title. 

Alabama Assessment Report For Insurance Companies, Self-Insurers And Group Funds WCC Form 10 Step 15: Sign the form and give your title.  

INSTRUCTIONS: CONNECTICUT PREFERRED PROVIDER NETWORK (PPN) LICENSE INSTRUCTIONS AND APPLICATION (INITIAL)

To apply for an initial license to act as a Connecticut preferred provider network (PPN), use the form discussed in this article. This document can be obtained from the website maintained by the government of Connecticut.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 1: The first page contains general instructions for completion.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 2: On the first five blank lines of the second page, enter the PPN name, its tax identification number or federal employer identification number, its business address, its mailing address (if different) and its phone number.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 3: The next six lines concern contact information to be used by the state Insurance Department for all future correspondence. Enter the name and title of a contact person, their mailing address, their phone number, their fax number and their email address.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 4: Indicate whether your company provides services for workers compensation only by filling in the oval next to "Yes" or "No." If yes, you do not need to complete the remainder of the application and may skip to the CEO certification on page 7.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 5: Indicate whether your organization is registered with the Insurance Department as a Pharmacy Benefit Manager by filling in the oval next to "Yes" or "No." If yes, you do not need to complete the remainder of the application and may skip to the CEO certification on page 7.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 6: Enter the name and a description of your controlling company or organization.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 7: Enter a contact name for your controlling company and organization, as well as their business and mailing addresses.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 8: Enter the name of your related or predecessor controlling company or organization and its address at the top of the third page.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Initial) Step 9: Complete the rest of the form as instructed.

INSTRUCTIONS: CONNECTICUT ITEMIZED CAMPAIGN FINANCE DISCLOSURE STATEMENT (SEEC Form 20)

If a Connecticut campaign spends or incurs expenses of more than $1,000 or receives that amount or more in contributions and donations, an itemized campaign finance disclosure statement must be filed for the period in question. This document can be obtained from the website of the government of Connecticut.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 1: On line 1, enter the name of the committee.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 2: On line 2, enter the title and full name of the treasurer.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 3: On line 3, enter the full address of the treasurer.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 4: On line 4, enter the date of the referendum or election.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 5: On line 5, enter the office sought.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 6: On line 6, enter the district number if applicable.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 7: On line 7, enter the title and full name of the candidate.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 8: On line 8, indicate the type of report being filed with a check mark.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 9: On line 9, enter the beginning and ending dates of the period being covered.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 10: The treasurer or deputy treasurer should sign and print their name on line 10, as well as providing the date.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 11: At the top of the second page and all subsequent pages, enter the name of the committee and the type of report being filed.

Connecticut Itemized Campaign Finance Disclosure Statement SEEC Form 20 Step 12: The second page summarizes all information that must be provided. In order to complete lines 11 through 28a, it will be necessary to complete Sections A through S, which are provided in this form packet. Additional pages of most sections are provided if you require additional space for complete documentation.

INSTRUCTIONS: CONNECTICUT PROPERTY EXECUTION PROCEEDINGS APPLICATION, ORDER, EXECUTION (Form JD-CV-5CAL)

When a Connecticut case has resulted in a judgment against the debtor but full or partial payment has not been made as ordered, the judgment creditor should complete a form JD-CV-5CAL to request enforcement of the ruling. This document can be found on the website of the Connecticut Judicial Branch.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 1: The application section should be completed by the judgment creditor or their attorney. In the first blank box, enter the address of the court and indicate with a check mark whether it is a geographical area, judicial district or housing session court.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 2: In the second blank box, enter the date of judgment.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 3: In the third blank box, enter the docket number.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 4: In the fourth blank box, enter the name and address of the judgment creditor or creditors making this application.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 5: In the fifth blank box, enter the name and address of the judgment debtor or debtors.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 6: In box 1, enter the amount of judgment.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 7: In box 2, enter the amount of costs and fees.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 8: In box 3, enter the total of the judgment amount, costs and fees.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 9: In box 4, enter the total amount paid, if any.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 10: In box 5, enter the total amount unpaid by subtracting box 4 from box 3.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 11: In box 6, enter the application fee for property execution if not waived by the court. Add boxes 5 and 6 and enter the resulting sum in box 7.

Connecticut Property Execution Proceedings Application, Order, Execution JD-CV-5CAL Step 12: Complete the rest of Section I as directed. Section II will be completed by the assistant clerk of the court.

INSTRUCTIONS: CONNECTICUT MOTION FOR DEFAULT FOR FAILURE TO APPEAR, JUDGMENT AND ORDER FOR WEEKLY PAYMENTS (Form JD-CV-49)

In a Connecticut case where the debtor has failed to file an appearance within two days of the return date, a form JD-CV-49 is filed to request a motion for default and an order for weekly payments. This document can be obtained from the website of the Connecticut Judicial Branch.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 1: Enter the return date and the docket number at the top right-hand corner.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 2: Indicate with a check mark whether the case is being processed by a judicial district court, a housing session court, or a geographical area court. If the latter, give its number. Enter the address of the court.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 3: Enter the name of the case.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 4: Enter the name of all defendants against whom the motion is being filed.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 5: In the next section, indicate whether you are seeking nominal or reasonable weekly payments. If the latter, enter the amount of weekly payment you wish to be ordered.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 6: Enter the name and address of the person completing this form, who should also provide their signature, indicate whether they are the plaintiff or their attorney with a check mark, and provide the date.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 6: The next section requires you to state whether you are unaware of the defendant's military service or if you are aware for a fact they are not in the military.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49 Step 7: In the bottom left-hand corner, enter your debts for each category listed. Complete the section on the right when all defendants have been served with a copy of this form.

INSTRUCTIONS: CONNECTICUT APPLICATION FOR HEARING ON EXEMPT STATUS OF FUNDS (Form JD-CV-72)

When a judgment creditor in a Connecticut foreclosure status believes some of the funds claimed as exempt from execution by the judgment debtor are eligible for execution, they should file a form JD-CV-73 stating the basis for their belief. If the presiding judge concurs, they should then file a form JD-CV-73 to request a hearing. Both forms can be found on the website of the Connecticut Judicial Branch.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 1: In the first blank box, enter the docket number.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 2: In the second blank box, enter the name of the case.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 3: In the third blank box, enter the name of the judgment creditor.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 4: In the fourth blank box, enter the name of the judgment debtor.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 5: In the fifth blank box, enter the amount of the funds claimed as not exempt.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 6: In the sixth blank box, enter the type of funds.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 7: Check the first box on the next line if the case is being processed by a judicial district. Enter its name.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 8: Check the second box if the case is being processed by a small claims area. Enter its name.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 9: Check the third box if the case is being processed by a housing session. Enter its name.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 10: Check the fourth box if the case is being processed by a G.A. Enter its name.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 11: Sign and date the form where indicated.

Connecticut Application For Hearing On Exempt Status Of Funds JD-CV-72 Step 12: When filing, your approved form JD-CV-73 must be attached.