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Workers' Disability Compensation Agency
Black Leadership Advisory Council
Michigan Community Service Commission
Executive Order 2020-107 established Michigan Workforce Development Board
MiSTEM convenes a statewide network of leaders in education, business and local communities to empower the next generation of innovators.
The Rural Development Fund Board, housed in the Office of Rural Prosperity, has oversight of the Rural Development Fund. The Board is charged with advising the Office on how to distribute tax revenue collected from mines to improve and strengthen local communities. Director is a voting member and makes final decision on projects (Public Act 411 of 2012).
Unemployment Insurance Appeals Commission
formerly MI Compensation Appellate Commission
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WC-100 - Employer's Basic Report of Injury (fill-in form)
WC-106 - Supplemental Report of Fatal Injury (fill-in form)
WC-107 - Notice of Dispute (fill-in form)
WC-108 - Application for Advance Payment (fill-in form)
WC-117 - Employee's Report of Claim (fill-in form)
WC-271 - Application for Reimbursement from the Medical Benefits Fund (fill-in form)
WC-272 - Application for First Responder Presumed Coverage (fill-in form)
WC-117H - Provider's Report of Claim and Request for Medical Payment
WC-581 - Application for Adjustment to the Workers' Compensation Maximum Payment Ratio
WC-590 - Application for Certification of a Carrier's Professional Health Care Review Program
WC-104B - Health Care Services Application for Mediation or Hearing (fill-in form)
WC-739 - Carrier's Explanation of Benefits
WC-750 - Provider's Request for Reconsideration (fill-in form)
WC-338 - Notice to Terminate Exclusion
WC-400 - Insurer's Notice of Issuance of Policy (fill-in form)
WC-400A - Insurer's Notice of Issuance of Specific Risk Policy
WC-401 - Notice of Termination of Liability (fill-in form)
WC-401A - Notice of Termination of Specific Risk Policy
WC-403 - Insurer's Notice of Name or Address Change (fill-in form)
WC-104A (Español) - Solicitud Para Mediación O Audiencia - Formulario A
WC-113 (Español) - Demanda de Redención
WC-117 (Español) - Informe de Reclamación Del Empleado
WC-119 (Español) - Declaracion que Apoya el Acuerdo de Redencion
WC-500 (Español) - Proveedor de Rehabilitación Vocacional Declaración de Divulgación Profesional
WC-40 - Request for Compliance Hearing (fill-in form)
WC-104A - Application for Mediation or Hearing (fill-in form)
WC-104B - Health Care Services Application for Mediation or Hearing (fill-in form)
WC-104C - Defendant's Application for Mediation or Hearing (fill-in form)
WC-105A - Work History, Work Qualifications and Training Disclosure Questionnaire (fill-in form)
WC-105B - Employer Disclosure Questionnaire (fill-in form)
WC-113 - Redemption Order (fill-in form)
WC-113A - Multiple Carrier Redemption Form (fill-in form)
WC-115 - Voluntary Payment Form (fill-in form)
WC-119 - Affidavit in Support of Redemption (settlement) Agreement (fill-in form)
WC-200 - Opinion/Order (fill-in form)
WC-251 - Carrier's Response (fill-in form)
WC-262 - Claim/Cross-Claim for Review (fill-in form)
WC-508- Subpoena for Production of Records (and/or) Witness Subpoena (fill-in form)
WC-544 - Worker's Settlement Statement (fill-in form)
WC-556 - Agreement to Redeem Liability (fill-in form)
WC-556A - Addendum to Agreement to Redeem Liability (fill-in form)
WC-402 - Self-Insurer Application Packet (fill-in form)
WC-402A - Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form)
WC-402G - Group Self-Insurer Application Packet
WC-402GR - Group Self-Insurer Application (fill-in form)
WC-404 - Service Company Application (fill-in form)
WC-650 - Self-Insured Group Notice of Acceptance of Membership (fill-in form)
WC-651 - Notice of Termination of Membership (fill-in form)
Letter of Credit/Memorandum of Understanding (fill-in form)
Michigan Continuous Surety Bond (fill-in form)
Michigan Certificate of Specific/Aggregate Excess Liability Insurance (fill-in form)