Get Fl1372

Filling out the Fl1372 form can seem daunting, especially for those new to this process. This guide provides step-by-step instructions to help users complete the form accurately and efficiently, ensuring compliance with all necessary requirements.

Follow the steps to complete the Fl1372 form online.

1. Click the ‘Get Form’ button to obtain the Fl1372 form and open it in your preferred editor or platform.
2. In Item 1, provide the termination date of the previous labor contractor’s service. Ensure the date is in the correct format.
3. In Item 2, enter the name of the previous labor contractor and include the corresponding Risk ID.
4. In Item 3, provide the name and address of the client company along with its Federal Employer Identification Number (FEIN). Include the Risk ID as well.
5. In Item 4, mention the name of the new labor contractor if the client company has entered into a leasing arrangement.
6. In Item 5, fill out the policy information for the period when the client's reported data was developed. Provide the effective date, expiration date, policy number, carrier name, and the state.
7. Complete Columns 1 to 13 with the required details. In Column 1, list the appropriate workers compensation classification code; in Columns 2 and 3, record payroll and rates.
8. Fill in Column 4 with unique claim numbers for losses over $2,000, and use Columns 6 and 10 for lumped medical or smaller claims.
9. Document the date of the accident in Column 5 and the injury types in Column 6 using the codes provided.
10. Indicate if claims are open or closed in Column 7, and complete Columns 8 to 13 with the relevant data on losses.
11. Review all entries for accuracy, ensuring that payroll and losses are correctly rounded and stated.
12. Finally, save changes, download, print, or share the completed form based on your needs.

Complete your Fl1372 form online today for a smooth and efficient experience.