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IIC Forms
(WordPerfect 5.1 format)
Form IC1: Application for Adjustment of Claim (Application for Benefits)
Form IC4: Notice of Motion and Order
Form IC5: Settlement Contract Lump Sum Petition and Order Note: This Form is on pink paper
Form IC6: Appearance of Representative
Form IC7: Petition for an Immediate Hearing under Section 19(b) of the Act Note: This Form is on blue paper
Form IC8: Response to Petition for an Immediate Hearing under Section 19(b) of the Act Note: This Form is on goldenrod paper
Form IC9: Request for Hearing
Form IC10: Attorney Representation Agreement
Form IC11: Petition for Review of Arbitration Decision Note: This Form is on orchid paper
Form IC11a: Petition for Review of Arbitration Decision under Section 19(b-1) of the Act Note: This Form is on orange paper
Form IC14: Petition for Review under Section 19(h) or 8(a) of the Act Note: This Form is on aqua paper
Form IC14a: Petition for Immediate Hearing under Section 19(b-1) of the Act Note: This Form is on gray paper
Form IC14b: Response to Petition for Immediate Hearing under Section 19(b-1) of the Act Note: This Form is on green paper
Form IC14c: Notice of Pretrial Hearing under Section 19(b-1) of the Act
Form IC14d: Order to Dismiss or Withdraw Petition under Section 19(b-1) of the Act
Form IC15: Proof Service Note: This Form is on pink paper
Form IC17: Motion to Voluntarily Dismiss Case
Form IC19: Order to Dismiss Case for Want of Prosecution
Form IC23: Petition to Reinstate Case
Form IC27: Motion to Dismiss Attorney of Record
Form IC28: Motion to Withdraw as Attorney of Record
Form IC29: Stipulation to Substitute Attorneys
Form IC30: Notice of Refiled Petition under Section 19(b-1) of the Act
Form IC31: Rehabilitation Plan
Form IC32: Notice of Rejection of Settlement Contract
Form IC33: Dedimus Potestatem
Form IC34: Decision/Order
Form IC36: Request for Voluntary Arbitration
Form IC41: Arbitration In Formation Sheet
Form IC42: Request for Verification of Employer's Insurance Coverage
ILLINOIS INDUSTRIAL COMMISSION REQUEST FOR FORMS
