After the parties have reached an agreement to settle a case by lump sum, this form is filed. When the DIA receives this form, it schedules a conference, at which the agreement is approved by a DIA judge.

This is the only form filed prior to the conference. All other forms, including the actual Lump Sum Agreement form ( Form 117 pdf format of Form 117
or 117A pdf format of Form 117A
), and forms 116A, 116B, and 116C, are presented to the judge at the conference.

Print Form 116  pdf format of form-116.pdf