Forms, Publications, and Reports
OSIP Online Services User Guides
Information Bulletin
Fiscal Year
- FY 2022-2023 Methodology
- FY 2021-2022 Methodology
- FY 2020-2021 Methodology
- FY 2019/2020 Methodology
- FY 2018/2019 Methodology
- FY 2017/2018 Methodology
- FY 2016/2017 Methodology
- FY 2015/2016 Methodology
- FY 2014/2015 Methodology
- FY 2013/2014 Methodology
- FY 2012/2013 Methodology
- FY 2011/2012 Methodology
- FY 2010/2011 Assessments
Newsline
- The Office of Self-Insurance Plans Adopts New Reporting Regulations Affecting Self-Insured Employers
- OSIP Posts Proposed Regulations and Public Meeting Announcement
- OSIP announces the release of the new Actuarial Summary form
- OSIP posts FAQs on SB 863 requirements for self-insurers
- OSIP Newsline 7-12 - OSIP announces SB 863 emergency regulations
- OSIP Newsline 6-12 - California's Alternative Security Program puts $6.17 Billion in Capital Back into Businesses
- OSIP Newsline 5-12 - Issues default order against Administrative Concepts Corp.
- OSIP releases regulatory guidance on developing actuarially based rate plans to self-insured groups
- Office of Self-Insurance Plans (OSIP) strengthens oversight of self-insured groups
- OSIP Newsline 01-12 OSIP launches audit web tools
- OSIP Newsline 02-11 OSIP to improve audit procedures in 2012
- OSIP Newsline 01-11 Amended OSIP regulations become effective Oct. 19, 2011
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Statewide Totals
Rosters
Security Deposit
Forms
- Excess Credit Calculation Form
- Form A-1 (1-2016)
Application for a Private Entity Certificate of Consent to Self-Insure - Form A-2 (1-2016)
Application for a Public Agency Certificate of Consent to Self-Insure - Form A-3A (1-2016)
Private/Public Interim Application - Form A-3B (1-2016)
Application for a Permanent Certificate of Consent to Self-Insure by an Interim Self-Insurer - Form A-4 (1-2016)
Guaranty of Workers' Compensation Liabilities - Form A4-50
Application for a Certificate to Administer W/C Claims - Form A4-100
Application for a Self Insurance Administrator's Examination - Form A-5 (1-2016)
Corporate Resolution Authorizing Application - Form A-6 (1-2016)
Agreement and undertaking for security deposit - New Public Entity Reporting Guidelines and FAQs 2021
- Form S-1 (1-2016)
Group master application for certificate of consent to self-insure - Form S-2A (1-2016)
Group affiliate member interim application - Form S-2B (1-2016)
Application for affiliate certificate of consent to self-insure as a member of a group self-insurer - Form S-3 (1-2016)
Corporate resolution - Form S-4 (1-2016)
Indemnity agreement and power of attorney - Form S-5 (1-2015)
Agreement of assumption and guarantee of workers’ compensation liabilities for group and affiliate members - Form S-6 (1-2016)
Agreement and undertaking for security deposit - Resolution of Agreement of Parental Assumption and Guarantee
- Report of Transfer of Records
- Life tables for men and women: United States 2020
NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2023 and will be utilized by OSIP in 2024 to determine if the figures provided on the 2023 Annual Report are accurate. - Life tables for men and women: United States 2018
NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2022 and will be utilized by OSIP in 2023 to determine if the figures provided on the 2022 Annual Report are accurate. -
Life tables for men and women: United States 2017
NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2020 and 2021 and will be utilized by OSIP in 2021 and 2022, respectively, to determine if the figures provided on the 2020 and 2021 Annual Report are accurate.
November 2021