Missouri Department of Labor and Industrial Relations Missouri Department of Labor and Industrial Relations

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Division of Workers' Compensation
Second Injury Fund Surcharge

Electronic Partnering/Confidentiality Agreement Affidavit of Zero Reporting (Commercial Insurers Only) Affidavit of Zero Reporting (Memorandum) Web Enabled Filing of Second Injury Fund Surcharge Quarterly Report Forms Online Report of Second Injury Fund Surcharge Quarterly Forms Electronic Transfer Enrollment Form (WC-132)
 
 
 
 
 

If you need assistance, please email SIFSURCHARGE@LABOR.MO.GOV or call (573) 526-3543 or (573) 526-3974.

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Governor
Mike Kehoe

Mo.gov State of Missouri

Acting Director
Anna S. Hui

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Missouri Department of Labor and Industrial Relations is an equal opportunity employer/program. TDD/TTY: 800-735-2966 Relay Missouri: 711