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Industry Information

PEO - Employee Leasing Forms

Posted Date: August 27, 2026
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​​​ Industry InformationProfessional Employer Organizations (PEO)

Professional Employer Organization (PEO)—Employee Leasing Forms

NCCI’s Experience Rating Manual provides the conditions under which the client’s data must be reported by the employee leasing company's insurance provider. The client’s data is known as Experience Rating (ER) Split Data and represents the audited exposure, premium, and loss information for the individual client employer. ER Split Data is reported separately from Unit Statistical Data. For states that allow hard copy reporting of ER Split Data, use one of the forms listed below.Use one of the forms listed below.

  • National Employee Leasing Form NC2745 (PDF)
  • Florida Employee Leasing Form FL1372 (PDF) 
  • Nevada Employee Leasing Form NV361 (PDF)
  • Virginia Employee Leasing Form VA1271 (PDF)   

Refer to NCCI’s Experience Rating (ER) Split Data Reporting Guide for data reporting requirements. Go to Part 9—Hard Copy Reporting in the guide for instructions to properly complete these forms.

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