ACORD 181 KS (2005/11)

Section Name
Field Name
Field and/or Section Description
ACORD 181 KS (2005/11)
Kansas Cancellation of Election of
Coverage for Persons Performing
Public Service
Use this form to notify the Kansas Division of Workers Compensation that an employer
cancels a previous election to provide workers compensation coverage for persons
performing public or community service as a result of a contract of diversion, assignment
to a community corrections program or suspension of sentence or as a condition of
probation or in lieu of a fine.
ACORD 181 KS (2005/11)
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