Getting Started & Membership
For carriers and employers establishing or updating their relationship with PCRB.
- PCRB Membership – Pennsylvania Membership Request Form
- NRQ-PA – New Risk (Employer) Questionnaire
Ownership & Executive Officer Information
For reporting ownership details and officer status.
- Ownership (ERM-14) Form – General Ownership Information Request
- LIBC 509 – Application for Executive Officer Exception
- LIBC 513 – Executive Officer’s Declaration
Experience Rating & Prior Coverage
For experience rating history and prior self-insurance information.
- ERM-6 – Experience Rating – Former Self-Insurers Data Request