ACORD 174 KS (2005/11)

Section Name
Field Name
Field and/or Section Description
ACORD 174 KS (2005/11)
Kansas Election Not to Accept
Use this form to notify the Kansas Division of Workers Compensation that an employee
who owns 10% or more of the stock in a corporation elects not to accept workers
compensation coverage.
ACORD 174 KS (2005/11)
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