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FREQUENTLY USED NJ FORMS
New Jersey Form Title
NJCRIB Bureau
Manual Reference
(Click to view form in PDF format)
(Click below to review the applicability and proper use of the forms.)
Acceptance of
Bureau Membership and Designation
Part 1: Section 4
Acceptance of
New Jersey Workers Compensation Insurance Plan
Part 1: Section 4
Application of
New Jersey Construction Classification Premium Adjustment Program
Part 3: Section 8
ACORD 132NJ
(7/2006)
New Jersey Workers Compensation Insurance Plan
Instructions and Rules
Part 3: Section 14
ACORD 133NJ
(1/2008)
New Jersey Workers Compensation Insurance Plan
Application For Designation Of An Insurance Company
Part 3: Section 14
ACORD 134NJ
(1/2007)
New Jersey Workers Compensation Insurance Plan
Notice Of Election - Proprietors and Partners
Part 3: Section 14
ACORD 135NJ
(09/2009)
New Jersey Workers Compensation Insurance Plan
Client Supplemental Employee Leasing Application
Part 3: Section 14
ACORD 136NJ
(9/2009)
New Jersey Workers Compensation Insurance Plan
Truckers Supplemental Application
Part 3: Section 14
Form 16 NJ
(4/2000)
Posting Notice
Part 3: Section 2
Form NJ LR-LD
(6th Rev)
Large Risk — Large Deductible Program
Notice Of Election (Effective 7/1/06)
Part 3: Section 10A
Form NJRR-1
(8th Rev)
New Jersey Notice Of Election —
Retrospective Rating
Part 3: Section 12
Form NJRR-2
New Jersey Notice Of Election —
Retrospective Rating
(Effective 1/1/05)
Part 3: Section 12
Form PP-1B
New Jersey Notice Of Election —
Proprietors And Partners
Workers Compensation and Employers Liability Insurance
Part 3: Section 2
Form #Req 11:6-2.3(d)
Application for An
Approved Managed Care Program
Premium Reduction
Part 3: Section 10B
XM1-99
Experience Rating Data Form - Front
Part 3: Section 11
Form XM1-99
Experience Rating Data Form - Back - Instructions
Part 3: Section 11
USR-ASWG Form A
Primary Unit Statistical Reporting Form
Part 3: Section 13
USR-ASWG Form NJ
Optional - Special NJ Only Form
Part 3: Section 13
ICR-ASWG
Individual Claim Report Form
Part 3: Section 13
ICR-ASWG (Back)
Individual Claim Report Form (Back)
Part 3: Section 13
Transmittal Letter
(Form TL-1)
New Jersey CRIB Hard Copy Transmittal Letter (Form TL-1)
Letter of Transmittal
(Form S-31NJ)
New Jersey - Letter of Transmittal (Form S-31NJ)
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