ACORD 177 KS (2005/11)

Section Name

Field Name

Field and/or Section Description

TITLE

ACORD 177 KS (2005/11)

Kansas Election of Coverage for

Volunteer Workers

Use this form to notify the Kansas Division of Workers Compensation that an employer

elects to provide workers compensation coverage for volunteer workers.

ACORD 177 KS (2005/11)

1 of 1