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 ( or ), and forms 116A, 116B, and 116C, are presented to the judge at the conference.

Print Form 116  pdf format of form-116.pdf