Skip Ribbon Commands
Skip to main content
Home


Assigned Risk: ACORD Forms

ACORD Forms 130 & 133, with instructions, for submitting assigned risk applications.

To complete Indiana assigned risk applications, you may:

  • complete an application online from the NCCI website at www.ncci.com. You will be using the RMAPS Online Application Service. You will need an NCCI ID. To get one, call 800-NCCI-123, or
  • complete and mail the ACORD 133 Workers Compensation Insurance Plan Assigned Risk section and ACORD 130 Workers Compensation Application. To get ACORD Forms, see documents below. To contact ACORD, call 1-800-444-3341 or visit www.acord.com. ACORD also has fillable forms which have the same look and feel as the paper and PDF versions. You can fill out each form on screen and with the click of a button, email, print, save or fax it.

Below are the documents which you can open and print.
 

 

Related Files

The material in this document has been prepared and shared for informational purposes only and should not be relied upon as legal advice on any particular situation.