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 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, contact ACORD​(845) 620-1700 or 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.

Back to List