This section contains ACC claims forms and fact sheets for you to print. Forms may be completed and posted or faxed to us.
Downloading and requesting forms
Most of these documents are in PDF format. For more help about accessing PDFs, please go to Downloading software.
If you want forms and fact sheets to be posted out to you go to ACC publications.
General claims information
Forms
ACC001 Request for assistance (PDF656K)
ACC249 Request for reimbursement of Pharmaceutical Costs (DOC142K)
ACC167 Authority for the collection and disclosure of information (DOC101K)
Fact sheets
ACC592 Getting help if you’re injured visiting our country (PDF1.4M)
ACC593 Getting help with an injury if you’ve been travelling overseas (PDF1.5M)
ACC577 Getting help with surgery after an injury (PDF477K)
ACC583 Help for injuries (PDF415K)
ACC2399 How you can get help after an injury (PDF344K)
INOIS01 Requesting Official Information (DOC100K)
INPIS01 Collection and Disclosure of Information (DOC100K)
INPIS02 Requesting Personal Information (DOC100K)
Death from injury
Forms
ACC136 Funeral grant payment authority (DOC81K)
Fact sheets
ACC586 Getting help after someone dies from an injury (PDF408K)
Treatment injury
Forms
ACC2152 Treatment injury claim (DOC123K)
Fact sheets
ACC589 Getting help with an injury caused by treatment (PDF85K)
Dental injury
Fact sheets
ACC591 Getting help for dental Injuries (PDF740K)
Hearing loss
Fact sheets
HLSIS01 Assessing cover for your gradual hearing loss (DOC107K)
HLSIS02 How we can help with your hearing loss (DOC105K)
Sexual abuse or assault
Fact sheets
SCUIS01 How we can help with a mental injury resulting from sexual assault or abuse (PDF26K)
Managing at home and work
Fact sheets
FSREB05 Help at home while you recover (PDF876K)
FSREB12 Artificial Limbs – Supporting your independence (PDF20K)
FSREB02 Supporting your independence - Equipment (PDF51K)
Children
Fact sheets
FSREB09 Supporting your child’s independence – Education Support (PDF19K)
Transport
Forms
ACC250 Request for transport costs (DOC99K)
Fact sheets
FSENT02 Travel to treatment or rehabilitation (DOC103)
Serious/long-term injuries and permanent impairment
Forms
ACC54 Application for Lump sum/independence allowance (DOC125K)
ACC554 Medical Certificate (DOC172KB)
Fact sheets
FSVI01 Vocational Independence Assessment – Assessing your fitness to return to work (DOC45K)
FSLA08 Independence allowance: Different assessment approaches (PDF15K)
FSAES01 Lump sum compensation - for injuries occurring on or after 1April2002 (PDF23K)
Weekly compensation
Fact sheets
FSWC01 Weekly compensation - general information (PDF 34K)
FSWC02 Weekly compensation - employee (PDF 30K)
FSCW03 Weekly compensation - self-employed (PDF 33K)
FSWC04 Weekly compensation – shareholder employee (PDF 37K)
FSWC05 Earning while on weekly compensation (PDF 40K)
FSWC06 Interim weekly compensation (PDF 23K)
Complaints, reviews and appeals
Forms
ACC33 Application for Review (PDF37K)
ACC034 Request to withdraw a review application (PDF20K)
ACC709 Code of ACC Claimants’ Rights complaint form (PDF31K)
Fact sheets
ACC255 Working Together (PDF498K)
ACC2393 Working together to resolve issues (PDF363K)
Code of ACC Claimants’ Rights fact sheets
Note:
The An Introduction to the Code of ACC Claimants’ Rights fact sheets have been discontinued. Please refer to the Working together to resolve issues fact sheets below as they now include information on the Code of ACC Claimants’ Rights.
ACC2393 Working together to resolve issues (PDF363K)
ACC5320 Working together to resolve issues (Cook Islands Maori) (PDF724K)
ACC5321 Working together to resolve issues (Samoan) (PDF3.1M)
ACC5322 Working together to resolve issues (Tongan) (PDF661K)
ACC5323 Working together to resolve issues (Maori) (PDF1.1M)
ACC5324 Working together to resolve issues (Hindi) (PDF798K)
ACC5325 Working together to resolve issues (Chinese) (PDF960K)
ACC5326 Working together to resolve issues (Korean) (PDF1.0M)
Cultural Access fact sheets
Te tauturu te ka rauka mai me mate ake tetai tangata no te pakia (injury) tei tupu ki tona kopapa
Anga ha’o ma’u ha tokoni hili ha’o lavea
Ko hano ma’u atu ha tokoni hili ha malolo ’a ha taha mei´ ha lavea
Ko hano ma’u atu ha tokoni kapau ’oku´ ke lavea lolotonga ha’o ’eve’eva mai ki homau fonua´
Ko hano ma’u atu ha tokoni ’i ha'o lavea lolotonga ha’o folau atu ki tu’apule’anga
Ko ha talateu ki he ngaahi Lao mo e Totonu ’a e Tokotaha ’Eke/Kole Huhu’i ki he ACC
뉴질랜드 방문 도중 상해를 입은 분들을 위한 지원 제도
Employers and Agents
Forms
Return to work plan template - basic (DOC29K)
Fact sheets
ACC1695 Helping employees get back to work: Step by step overview (PDF55K)
ACC1699 Helping employees get back to work: Common questions (PDF53K)
ACC1701 Helping employees get back to work: Workplace assessments (PDF50K)
Last updated: 21July2010