Documents & Forms

Assessment Rates Schedules, Remittance Slips and Statutes

Treasurer's Letter For Fiscal Year 2027
Treasurer Russell's Assessment Rate Letter - May 1, 2026
Assessment Rates Schedule
Assessment Rates Schedule - Updated - April 27, 2026
Quarterly Remittance Advice*
Two steps are required for submitting the quarterly findings:
1. Complete and submit payment of the Quarterly Remittance Advice - 2nd Quarter 2026 [Updated 6/29/2026]
2. Download complete and submit the Quarterly Remittance Template [Updated 12/2020]
Archived Remittance Slips
Paid Loss and Surcharge Base Report
Two steps are required for submitting the yearly Paid Loss and Surcharge Base Report:
1. Complete and submit the 2025 Paid Loss Surcharge Base Report [Updated 1/13/2026]
2. Download, complete and submit one of the following:
  - Insurance Company - Paid Loss Template
  - Self-Insured Company - Paid Loss Template
Annual Report to Governor
Connecticut Second Injury Fund Statutes and Regulations
- Statutes on Assessments for policies dated 7/1/06 and forward
- Regulations on Assessments for policies dated 6/30/06 and prior

* Note: Penalty on Late Assessment Payments, as of 2010: Any employer or any insurance company acting as collection agent for the custodian of the Second Injury Fund who fails to pay in accordance with such regulations shall pay a penalty to the State Treasurer of fifteen per cent on the unpaid assessment or surcharge or fifty dollars, whichever is greater. Act Concerning Interest Penalties on Late Payment of Assessments to the Second Injury Fund