Arkansas Labor & LicensingArkansas Workers' Compensation Commission

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Download the Application for Certificate of Non-Coverage (Form A) at the link below. Complete the Application, have the Affidavit notarized, and decide on a payment option.

Certificates of Non-Coverage

Applications can be mailed, along with the notarized affidavit and a check or money order for $50, to the address at the top of the form. To receive an expedited electronic copy of your Certificate, provide your email address and phone number on the Application.


We accept Online Payments for Certificates of Non-Coverage. Applications must be completed, and the affidavit notarized before starting the online payment process.

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Early-Bird registration is now open for the 2023 Educational Conference. Attendees can register through Whova at the following link

For more information regarding the conference as well as additional information on becoming an EXHIBITOR or SPONSOR at the conference please click on the Conferences link on the left side of this page.

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Rule 099.41 AWCC Drug Formulary
(effective July 1, 2018)
Click here for further information.

Beginning Jan 1, 2013
Form 1: New Requirements
Form 2: New Form 2 and Instructions
Form 4: New Requirements
Form D: New Requirements

"The Mission of the Arkansas Workers' Compensation Commission is to administer and enforce Arkansas Workers' Compensation Law as authorized by the Constitution and enacted by the Legislature."

Visit the Arkansas State Home Page

State of Arkansas
Workers' Compensation Commission
324 South Spring Street
P.O. Box 950
Little Rock, Arkansas 72203-0950
Telephone 1-501-682-3930 / 1-800-622-4472
Legal Advisor Direct 1-800-250-2511
Arkansas Relay System TDD 1-800-285-1131

For information or comments regarding this site,
or for information about how to obtain public records,
contact the AWCC Communications Liaison

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