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Quarterly Report for Self-Insured Business (F207-006-000). Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers (F207-011-000).Stop Payment - Form 1003, This document is a PDF. (1) The total value of assessments collected from self-insured employers under this section must be credited to the fund. The surcharge and supplemental surcharge are collected quarterly from insurance carriers and self-insurers. Woman completing form. Browse Workers' Compensation forms and publications below. Who pays for unemployment benefits? The Kansas Employment Security Law requires employers to pay taxes to fund all eligible regular unemployment benefits. Complete Part A, Claimant's Statement, of the claim form.