Employers who have received a Certificate of Recognition (COR) incentive can use this form to request a refund of the remaining COR credit from their assessment account.

To complete this form electronically, follow these steps:

1. Click the “Download PDF” button. The downloaded form will be copied to the Downloads folder on your computer hard drive.
2. Open the form in Acrobat by right clicking on the PDF file>Open with>Acrobat to complete the form.

Please note that the form functionality will not work properly if the form is opened within an Internet browser, such as Microsoft Edge or Google Chrome.

You can download Acrobat Reader from Adobe Acrobat Reader DC Download | Free PDF viewer for Windows, Mac OS, Android.

For technical issues submitting this form, please contact our technical support team.