Notification of Additional Information (SORM-90)

Online entry of the SORM-90 is available through SORM’s secure portal, RMIS.

Required:
When an injured employee is granted extended sick leave, pooled sick leave or has child support payroll deductions, the employing agency must immediately notify SORM of that fact, by completing and submitting the SORM-90 form.

Filing Deadline:
The form must be received by SORM not later than the next working day after the change occurs.

Completed by:
The claims coordinator.

Instructions:

  1. Be sure to fill in the claim number, if known.
  2. All other blanks should be filled out as indicated or, if not applicable, mark N/A.
  3. The claims coordinator should sign the form.
  4. If child support is being deducted from the employee’s payroll, include copy of child support order.

Please note: If the leave that is granted affects the state health contribution, an amended DWC-3 must also be filed.

Distribution:
Fax a copy or mail the original to:
State Office of Risk Management

Retain a copy for your file.