Get Oh Ac-2 2018-2025

The OH AC-2 form is essential for managing permanent authorizations regarding representation before the Ohio Bureau of Workers' Compensation. This guide offers clear, step-by-step instructions for users to complete the form accurately and efficiently.

Follow the steps to successfully complete the OH AC-2 online.

1. Click the ‘Get Form’ button to access the OH AC-2 form and open it in your preferred online editor.
2. Fill in the policy number and entity details at the top of the form, ensuring that the information aligns with your employer records.
3. Indicate your intended action by marking the appropriate box for addition, change, or termination of the representation type.
4. Enter the effective date for the authorization change. This date marks when the new representation becomes valid.
5. Provide the name and representative ID number of the individual whose authorization is being changed. Ensure the details are accurate.
6. Select the specific type of representation by checking only one of the following options: employer-risk claim representative (ERC), risk-management representative (RISK), claim-management representative (CLM), or payroll service vendor (PSV).
7. Fill in the employer's telephone number, fax number, email address, and ensure a printed name and title are included.
8. The form must be signed by an authorized representative of the employer, indicating their agreement to the terms stated.
9. Lastly, review all the filled information for accuracy and completeness, then save changes, download, print, or share the completed form as required.

Complete your OH AC-2 form online today to ensure your representation is accurately managed.