INSTRUCTIONS: CONNECTICUT MOTOR CARRIER IDENTIFICATION REPORT (Form MCS-150CT)

To apply for a new intrastate Department of Transportation number or to update your information, use a form MCS-150CT. This document can be obtained from the website of the government of Connecticut.

Connecticut Motor Carrier Identification Report MCS-150CT Step 1: Indicate with a check mark if you are filing a new application, a biennial update or an application documenting changes, an out of business notification, or a reapplication following the revocation of a new entrant.

Connecticut Motor Carrier Identification Report MCS-150CT Step 2: Enter the name of the motor carrier in box 1 and your trade or doing business as (dba) name in box 2.

Connecticut Motor Carrier Identification Report MCS-150CT Step 3: Enter your principal street address in box 3, city in box 4, your state or province in box 5, your zip code in box 6, and colonia (if operating in Mexico only) in box 7.

Connecticut Motor Carrier Identification Report MCS-150CT Step 4: Enter your mailing street address in box 8, city in box 9, state or province in box 10, zip code in box 11 and (only if operating in Mexico) colonia in box 12.

Connecticut Motor Carrier Identification Report MCS-150CT Step 5: Enter your principal business phone number in box 13, a principal contact cell phone number in box 14, and your principal business fax number in box 15.

Connecticut Motor Carrier Identification Report MCS-150CT Step 6: Enter your US Department of Transportation number in box 16, your MC or MX number in box 17, your DUN & Bradstreet number in box 18, and your IRS tax identification number in box 19.

Connecticut Motor Carrier Identification Report MCS-150CT Step 7: Enter your email address in box 20.

Connecticut Motor Carrier Identification Report MCS-150CT Step 8: Enter your carrier mileage and the year in box 21.

Connecticut Motor Carrier Identification Report MCS-150CT Step 9: Indicate your company operations by checking all applicable statements in box 22.

Connecticut Motor Carrier Identification Report MCS-150CT Step 10: Indicate your operation classification by checking all applicable statements in box 23.

Connecticut Motor Carrier Identification Report MCS-150CT Step 11: Complete questions 24 through 29 as instructed.

Connecticut Motor Carrier Identification Report MCS-150CT Step 12: Sign and date section 30, as well as providing your title.

INSTRUCTIONS: ALABAMA REQUEST FOR DISABILITY ACCOMMODATION FOR INDUSTRIAL RADIOGRAPHY EXAMINATION

Disabled Alabama residents who will be taking an industrial radiography examination use the form discussed in this article to request accommodations for this exam. This document can be obtained from the website maintained by the Alabama Department of Public Health.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 1: In section 1, specify any disability-related needs that the Office of Radiation Control should be made aware of in order to provide appropriate accommodations for this examination.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step : In section 2, specify any prior accommodations you have received for this disability in an examination setting. If necessary, you may have a professional who is familiar with this disability complete this information. This professional can be a physician, psychologist, rehabilitation counselor or another type of related professional.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 3: In section 3, if you have not received prior disability accommodations for an examination, you must consult with the appropriate professional who is familiar with your disability and is capable of advising you as to what type of accommodation is needed.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 4: On the first blank line, enter your signature.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 5: On the second blank line, enter the date.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 6: On the third blank line, any professional who has helped you complete this form should enter their signature.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 7: On the fourth blank line, any professional who has helped you complete this form should enter the date.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 8: When filing this form, you must also attach a statement on letterhead stationery from a professional who is familiar with your disability, describing your disability and the type of accommodation needed.

Alabama Request For Disability Accommodation For Industrial Radiography Examination Step 9: To file the document, consult the separate instructional packet made available on the website of the Alabama Department of Public Health. This packet contains the address to which your exam application and all other documents must be mailed.

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.