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We recognize that our users may use a variety of Internet Browsers. In order to provide you with the best experience possible, we recommend using Google Chrome or Internet Explorer (IE) 11. These browsers have been tested to ensure optimal usability. NOTE: If you are using MS Edge you may experience problems preventing the Acknowledgement Letter from appearing when you have completed the 61A process. In order to resolve this MS Edge issue, you may need to choose another browser or you may need to use a different PDF viewer application and change your default PDF viewer to a compatible application such as Adobe Acrobat Reader DC, Foxit Reader, Sumatra PDF, or any other PDF viewer.Here's how to change your default PDF reader in Windows 10:
The Revocation of Prior Rejection of Coverage Form (Form 17A) should be filed when an officer wishes to revoke the officer's prior rejection of coverage under the Workers' Compensation Act (Act) filed with the Commission. The executive officer that elects to revoke a prior rejection of coverage should understand that they are now electing to accept coverage under the provisions of the Act.
Please have the following information available in order to complete this form: