Get Arkansas Workers Compensation Commission Form Ar-n N 324 Spring Street, Little Rock, Ar 72201 Mail

This guide offers a detailed overview of how to correctly fill out the ARKANSAS WORKERS COMPENSATION COMMISSION Form AR-N. Designed to support users of varying backgrounds, this guide will walk you through each section and instruction step-by-step, ensuring a seamless filing process.

Follow the steps to fill out the ARKANSAS WORKERS COMPENSATION COMMISSION Form AR-N

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling out the employee's information section. Provide the employee’s last name, first name, middle initial, and street address or P.O. Box. Indicate if there are any child support obligations by selecting either 'Current' or 'Past Due'. Make sure to include the employee's Social Security number, phone number, city, state, and zip code.
3. Next, move on to the employer's information section. Enter the employer’s name, street address or P.O. Box, the supervisor’s name, city, state, and zip code. Ensure all fields are filled out accurately.
4. In the accident information section, specify the date and time of the accident. Include the place of the accident and notify whether the employer has been informed about the accident.
5. Detail the nature of the injury by indicating what part of the body was injured and briefly describing the cause of the injury.
6. List any witnesses by providing their names and addresses.
7. Complete the authorization section that allows medical professionals to share necessary information related to the injury. Sign and date the form, ensuring your signature is clear and legible.
8. After completing all sections, review the entire form for accuracy. Once confirmed, you can proceed to save changes, download, print, or share the form as needed.

Take the next step in your claims process by completing the ARKANSAS WORKERS COMPENSATION COMMISSION Form AR-N online.