Form HS-36-A - Arkansas Workers' Compensation Commission - awcc state ar 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the 'Company Information' section. Enter your company name, address, city, state, zip code, FEIN, and NAICS. Ensure all details are accurate for proper identification.
  3. Indicate the application type by selecting either 'Initial', 'Renewal', or 'Termination of Participation'. If renewing, provide the approval number.
  4. Complete the contact information fields including the company contact's name, telephone number, title, and email address.
  5. In the 'Drug Testing Program' section, provide details about your program manager or third-party administrator including their name and contact information.
  6. Fill in the testing lab information as required. Include their certification number and attach any necessary documentation regarding MRO qualifications.
  7. Attach a summary report from your testing laboratory or a letter certifying that no tests were required during the year.
  8. Finally, complete the employer certification section by signing and dating the form. Ensure notarization is completed before submission.

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You will receive a weekly benefit of 66 2/3% of your average weekly wage, subject to a maximum amount. In 2017, the most you can receive is $661 per week. If you are temporarily totally disabled, you will receive benefits until you are able to return to work.
Typically, there are four basic eligibility requirements for workers' comp benefits: You must be an employee. Your employer must carry workers' comp insurance. You must have a work-related injury or illness. You must meet your state's deadlines for reporting the injury and filing a workers' comp claim.
Some states limit the length of time an injured worker can receive temporary benefits. This range can be three to seven years. That said, there is not usually a limit on permanent disability benefits. However, some states do stop weekly benefits when employees reach the age of 65.

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Most often, benefits are calculated and paid based on the average weekly wage. This is calculated by multiplying the employee's daily wage by the number of days worked in a full year. That number is then divided by 52 weeks to get the average weekly wage.
You will receive a weekly benefit of 66 2/3% of your average weekly wage, subject to a maximum amount. In 2017, the most you can receive is $661 per week. If you are temporarily totally disabled, you will receive benefits until you are able to return to work.
Sole proprietors and independent contractors in Arkansas are not required to carry workers' compensation insurance coverage but may opt to voluntarily purchase a policy. Even when it's not required, purchasing this policy is a smart decision. Your personal health insurance plan might exclude work injuries.
Businesses where there are two or fewer employees may not be covered. Railroad and maritime workers are covered by federal laws. The Arkansas Workers' Compensation Law does not apply to employment of agricultural farm labor, domestic help, or employment by non-profit, religious, charitable or relief organizations.
Ark. Code Ann. § 11-9-529 allows employers 10 days to report injuries. Those involving either more than 7 days of lost time or indemnity payments require Form 1.

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