Hawaii Administrative Rules
Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
Chapter 11 - TEMPORARY DISABILITY INSURANCE
Subchapter 6 - REPORTS
Section 12-11-86 - Other employer reports

Every employer for whom services are performed in employment shall file a report on a form prescribed by the director to determine liability for coverage within ten days after being mailed by the department. This report shall provide information such as: Under an insured plan, the insurance carrier name, number of employees covered, effective date of coverage, and the amount, if there is any employee contributions toward premium payments; under a self-insured plan, furnishing copies of the plan and financial statement, effective date of plan, number and classes of employees covered, and the amount, if there is any employee contributions toward premium payments; under a sick leave plan covered under an employer-employee collective bargaining agreement, the name of union, copy of agreement, effective and expiration date of agreement, and number and classes of employees covered.