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ACORD 178 KS (2005/11)
Kansas Cancellation of Election of
Employer To Cover Employees
Use this form to notify the Kansas Division of Workers Compensation that an employer
with less than $20,000 payroll, or an employer that is an agricultural pursuit, cancels a
previous election to provide workers compensation insurance for its employees.
ACORD 178 KS (2005/11)
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