Form 190-A, Mandated Benefits Reporting Form for Virginia (undated), http://www.scc.virginia.gov/boi/co/health/mandben.aspx
Va. Admin. Code tit. 14, agency 5, ch. 190, form FORMS (14VAC5-190)
Statutory Authority: §§ 12.1-13 and 38.2-233 of the Code of Virginia.