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 (PDF 656K)
ACC249 Request for reimbursement of Pharmaceutical Costs (DOC 142K)
ACC167 Authority for the collection and disclosure of information (DOC 101K)
Fact sheets
ACC592 Getting help if you’re injured visiting our country (PDF 1.4M)
ACC593 Getting help with an injury if you’ve been travelling overseas (PDF 1.5M)
ACC583 Help for injuries (PDF 415K)
ACC2399 How you can get help after an injury (PDF 940K)
INOIS01 Requesting Official Information (DOC 100K)
INPIS01 Collection and Disclosure of Information (DOC 100K)
INPIS02 Requesting Personal Information (DOC 100K)
Death from injury
Forms
ACC136 Funeral grant payment authority (DOC 81K)
Fact sheets
ACC586 Getting help after someone dies from an injury (PDF 408K)
Treatment injury
Forms
ACC2152 Treatment injury claim (DOC 123K)
Fact sheets
ACC589 Getting help with an injury caused by treatment (PDF 85K)
Dental injury
Fact sheets
ACC591 Getting help for dental Injuries (PDF 740K)
Hearing loss
Fact sheets
HLSIS04 Assessing cover for hearing loss (DOC 98KB)
HLSIS05 Helping with your hearing loss (DOC 92KB)
HLSIS06 Assistance from other agencies (DOC 86KB)
HLSIS07 Changes to funding for hearing services from 1 January 2011 (PDF 45KB)
Sexual abuse or assault
Fact sheets
SCUIS01 How we can help with a mental injury resulting from sexual assault or abuse (DOC 190K)
SCUIS02 All about support sessions after sexual abuse or sexual assault (DOC 229K)
Managing at home and work
Fact sheets
FSREB05 Help at home while you recover (PDF 876K)
FSREB12 Artificial Limbs – Supporting your independence (DOC 36K)
FSREB02 Supporting your independence - Equipment (DOC 67K)
Transport
Forms
ACC250 Request for transport costs (PDF 40K)
ACC253 Request for prior approval: Transport and accommodation assistance (PDF 37K)
Fact sheets
FSENT02 Travel to treatment or rehabilitation (PDF 28K)
Serious/long-term injuries and permanent impairment
Forms
ACC54 Application for Lump sum/independence allowance (DOC 125K)
ACC554 Medical Certificate (DOC 172KB)
Fact sheets
LSIAIS01 All About Lump Sum Payments & Independence Allowances (PDF 39K)
LSIAIS02 All About the Independence Allowance - Single Payment Offer (PDF 25K)
LSIAIS03 Impairment Assessment Reports for Full Self Cover Accredited Employers (PDF 19K)
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 (DOC 102K)
ACC034 Request to withdraw a review application (DOC 78K)
ACC709 Complaint form (DOC 101K)
Fact sheets
ACC255 Working Together (PDF 498K)
ACC2393 Working together to resolve issues (PDF 363K)
REVIS01 All about review hearings (PDF 92K)
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 (PDF 363K)
ACC5320 Working together to resolve issues (Cook Islands Maori) (PDF 724K)
ACC5321 Working together to resolve issues (Samoan) (PDF 3.1M)
ACC5322 Working together to resolve issues (Tongan) (PDF 661K)
ACC5323 Working together to resolve issues (Maori) (PDF 1.1M)
ACC5324 Working together to resolve issues (Hindi) (PDF 798K)
ACC5325 Working together to resolve issues (Chinese) (PDF 960K)
ACC5326 Working together to resolve issues (Korean) (PDF 1.0M)
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
뉴질랜드 방문 도중 상해를 입은 분들을 위한 지원 제도
Employers and Agents
Forms
Return to work plan template - basic (DOC 29K)
Fact sheets
ACC1695 Helping employees get back to work: Step by step overview (PDF 55K)
ACC1699 Helping employees get back to work: Common questions (PDF 53K)
ACC1701 Helping employees get back to work: Workplace assessments (PDF 50K)
Last updated: 24 May 2012