• The Online Report of Second Injury Fund Surcharge has been tested with Edge, Chrome, and Firefox. Some other browsers have not been tested and may or may not work with this application.
  • Your browser must be JavaScript enabled.
  • The computer you are using should be connected to a printer so you can print information shown.
  • This online application uses Secure Socket Layers (SSL). Data submitted using this application is encrypted in 128 bit key.
  • You should have an active email address for each user.

To update your browser for compatibility with the Online Second Injury Fund Surcharge Quarterly Report Forms, you may use the links provided here.

Microsoft Edge

Google Chrome

Mozilla Firefox