New Hampshire Code of Administrative Rules
Lab - Commissioner, Department of Labor
Chapter Lab 400 - WORKERS' COMPENSATION SELF-INSURANCE
Part Lab 405 - SATISFACTORY PROOF OF FINANCIAL ABILITY
Section Lab 405.02 - Application for Self-Insurance

(a) A first time applicant shall complete and file with the department a "Workers Compensation Self-Insurance Application" form WSCI-1 (2/2016), contained in appendix II if the applicant is a single employer, or a "Workers Compensation Self-Insurance Application-Group" form WSCI-1A (2/2016) contained in appendix II if the applicant is an association or group of employers , together with balance sheet data or the most recent annual report containing such data, payroll data, and an "Annual Financial Statement" form WCSI-11 (3/1975) contained in appendix II .

(b) Annually after first receipt of a self-insurance permit, the self - insurer shall complete and file with the department an "Annual Financial Statement" form WCSI-11, a "Report of Outstanding Liabilities" form WCSI-9 (3/1975), contained in appendix II, a "Workers' Compensation Self-Insurance Questionnaire" form WCSI-16 (9/2015), contained in appendix II, a full report of actuarial analysis and opinion, and the "Actuarial Opinion Summary Sheet" form WCSI-7 (9/2015), contained in appendix II.