Forms

Notice: Calculations within some PDFs do not work with the most recent version of Adobe Reader, Acrobat, and Acrobat Reader DC. If you are using a form that contains calculations, you can either complete the calculations manually or revert Adobe Reader or Acrobat back to any version before 11.0.11. Forms calculations do not work with any version of Adobe Acrobat Reader DC. More information can be found on the North Dakota Information Technology Department website.

  • Forms that are marked with a Y in the Fill column can be completed on-line through Adobe Acrobat Reader.
  • Users with Adobe 6.0 and above will need to change a setting before completing the forms so that the tabbing order works correctly. Open Adobe Acrobat, go to the tab on top labeled Edit, go to Preferences, and Accessibility. Make sure the box Use document structure for tab order when no explicit tab order is specified is not checked.
  • Dates must be entered in the following format: mm/dd/yyyy.
  • When printing a form from Adobe Acrobat, the Page Scaling needs to be set to None. This can be found under File, Print, Page Handling Section. There will be a section called Page Scaling with drop down options. Please select None from those options. If any of the other options are selected, additional white space will be added to the margins of the form and the form will shrink.

Insurance Department - Internal Form(s)

SFNTitleSizeDateFillable
10706 Boiler Inspection Report 441 kb 02/13/2015
Y
19291 Employee Suggestion Incentive Program 376 kb 07/02/2014
Y
52579 Payment Voucher/Authorization 434 kb 10/03/2014
Y
52655 Commercial Roof Questionnaire 525 kb 11/07/2013
Y
54180 Large Group Health Insurance Data Report 85 kb
Y
54181 Small Group Health Insurance Data Report 77 kb
Y
54182 Individual Health Insurance Data Report 100 kb
Y
58370 Prescription Connection Intake Application 696 kb 06/14/2012
Y
59018 Information Required to Insure Radio Towers and Equipment 203 kb 01/30/2012
Y