The CE-200 form is officially known as the Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. It is designed specifically for entities that either have no employees or are out-of-state entities engaging in contracts where all work is conducted outside New York State, aiming to certify their exemption from mandatory workers' compensation and disability benefits insurance. This form is crucial for businesses and individuals seeking permits, licenses, or contracts with government entities in New York State, ensuring they are not required to carry such insurances. For those ready to affirm their exemption status, a step-by-step process awaits through the completion of the CE-200 form.
Ready to confirm your exemption? Make sure to fill out the CE-200 form by clicking the button below.
In the regulatory landscape of New York State, entities seeking relief from the obligation to carry workers' compensation and/or disability benefits insurance must navigate the application process encapsulated by the CE-200 form. Dubbed the "Application for Certificate of Attestation of Exemption from New York State Workers' Compensation and/or Disability Benefits Insurance Coverage," this document serves as a formal request by entities that either employ no individuals or out-of-state entities engaging in contracts strictly executed outside New York State, aiming for exemption in workers’ compensation. Similarly, it extends to entities aiming for exemption in disability benefits, contingent on specific criteria around employment within the state. Intricately designed parameters delineate eligibility, specifically catering to entities without employees or those with minimal employee interaction in New York, emphasizing a rigorous definition of employment under the New York State Disability Benefits Law. The completion and submission process, offering both traditional and digital avenues, encapsulates a commitment to procedural adherence, while explicitly highlighting the exclusivity of its application to governmental entities from which an applicant seeks permits, licenses, or contracts. Beyond the binary caveats of eligibility and application process, the form delves into detailed requisites spanning personal information, legal entity identification, and specific exemption justifications, presenting a comprehensive framework aimed at simplifying the attestation of exemption in a legally binding context. This attestation, fundamentally, asserts the non-requirement of standard workers' compensation and/or disability benefits insurance by the applicant when engaging in governmental contracts, hence providing a critical facilitation in regulatory compliance for qualified entities.
New York State Workers' Compensation Board
Application for Certificate of Attestation of Exemption
from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage.
For NYS workers’ compensation exemption, this application may only be completed by entities with no employees or out-of-state entities obtaining contracts for which ALL work is performed outside of NYS. For NYS disability benefits exemption, it may only be completed by entities without employees or those with employees, as defined by the NYS Disability Benefits Law, working in NYS for less than thirty days in a calendar year.
A certificate of attestation of exemption can ONLY be used to attest to a government entity that the applicant requesting a permit, license or contract from that government entity is not required to carry workers’ compensation and/or disability benefits insurance.
The application must be completed in its entirety and submitted to the Workers’ Compensation Board by fax or mail. The application will be processed in the order received and a certificate of attestation of exemption will be mailed to the applicant. This process may take up to four weeks.
To obtain a certificate immediately, please use the on-line application at www.wcb.state.ny.us. Once the application is completed on-line, you can immediately print the certificate on your printer.
Please review the separate instructions (form CE-200 instructions) prior to completing this application. Please print clearly.
1. Applicant Personal Information:
First Name: ____________________________ Last Name: ______________________________________
Street Address: ____________________________________________________________________________
City: ___________________________________ State: ____________________ Zip: _________________
Country (If other than U.S.) __________________________________________________________________
Personal Phone Number ( ______ ) ___________________________
2.Your Title (check only one)
Sole Proprietor
Treasurer
President
Partner
Vice President
Member
Secretary
Trustee
Homeowner
Board Member
Other (please provide title) __________________________________________________________
3.Legal Entity Information:
Business Federal ID (If none, enter social security number): _________________________________________
Legal Entity Name: _________________________________________________________________________
Doing Business As Name_____________________________________________________________________
Business Phone: ( _______ )__________________E-mail __________________________________________
Check here if business address is the same as the applicant’s personal address. If different, enter business address below.
Business Street Address: _____________________________________________________________________
City: _________________________________ State: _____________________ Zip:_____________________
CE-200APPLY (2/2009)
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4.Permit/License/Contract Information:
A. Nature of Business:(please check only one)
Construction/Carpentry
Electrical
Demolition
Landscaping
Plumbing
Farm
Restaurant / Food Service
Trucking / Hauling
Food CartVendor
Horse Trainer/Owner
Hotel / Motel
Bar / Tavern
Mobile - Home Park
Other (please explain) ______________________________________________________________
B. Applying for:
License (list type) __________________________________________________________________
Permit (list type) ___________________________________________________________________
Contract with Government Agency
Issuing Government Agency: _____________________________________________________________
(e.g. New York City Building Department, Ulster County Health Department, New York State Department of Labor, etc.)
5.Job Site Location Information: (Required if applying for a building, plumbing, or electrical permit) A. Job Site Address
Street address________________________________________________________________________
City: _________________________ State: ___________ Zip: ________County: ________________
B. Dates of project: (mm/dd/yyyy) ___________________ to:(mm/dd/yyyy) _________________________
Estimated Dollar amount of project:
$0 - $10,000
$50,001 - $100,000
10,001- $25,000
Over $100,000
$25,001 - $50,000
6.Partners/Members/Corporate Officers -must list all with titles except for limited partnerships which must include only general partners. Sole proprietors can skip this section.
Name: ________________________________________
Title: _____________________________________
(Attach additional sheet if necessary)
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Employees of the Workers’ Compensation Board cannot assist applicants in answering questions in the following two sections. Please contact an attorney if you have any questions regarding these sections.
7.Please select the reason that the legal entity is NOT required to obtain New York State Specific Workers’ Compensation Insurance Coverage:
□A. The applicant is NOT applying for a workers' compensation certificate of attestation of exemption and will show a separate certificate of NYS workers' compensation insurance coverage.
□B. The business is owned by one individual and is not a corporation. Other than the owner, there are no employees, day labor, leased employees, borrowed employees, part-time employees, unpaid volunteers (including family members) or subcontractors.
□C. The business is a LLC, LLP, PLLP or a RLLP; OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members, there are no employees, day labor, leased employees, borrowed employees, part-time employees, unpaid volunteers (including family members) or subcontractors.
□D. The business is a one person owned corporation, with that individual owning all of the stock and holding all
□
offices of the corporation. Other than the corporate owner, there are no employees, day labor, leased employees, borrowed employees, part-time employees, other stockholders, unpaid volunteers (including family members) or subcontractors.
E.The business is a two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (each individual must hold an office and own at least one share of stock). Other than the two corporate officers/owners, there are no employees, day labor, leased employees, borrowed employees, part-time employees, other stockholders, unpaid volunteers (including family members) or subcontractors.
F.The applicant is a nonprofit (under IRS rules) with NO compensated individuals providing services except for
clergy; or is a religious, charitable or educational nonprofit (Section 501(c)(3) under the IRS tax code) with no compensated individuals providing services except for clergy providing ministerial services; and persons performing teaching or nonmanual labor. [Manual labor includes but is not limited to such tasks as filing; carrying materials such as pamphlets, binders, or books; cleaning such as dusting or vacuuming; playing musical instruments; moving furniture; shoveling snow; mowing lawns; and construction of any sort.]
□G. The business is a farm with less than $1,200 in payroll the preceding calendar year.
□H. The applicant is a homeowner serving as the general contractor for his/her primary/secondary personal residence. The homeowner has no employees, day labor, leased employees, borrowed employees, part-time employees or subcontractors. The homeowner ONLY has uncompensated friends and family working on his/her residence.
I.Other than the business owner(s) and individuals obtained from a temporary service agency, there are no employees, day labor, leased employees, borrowed employees, part-time employees, unpaid volunteers (including family members) or subcontractors. Other than the business owner(s), all individuals providing services to the business are obtained from a temporary service agency and that agency has covered these individuals for New York State workers' compensation insurance. In addition, the business is owned by one individual or is a partnership under the laws of New York State and is not a corporation; or is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (in a two person owned corporation, each individual must be an officer and own at least one share of stock). A Temporary Service Agency is a business that is classified as a temporary service agency under the business’s North American Industrial Classification System (NAICS) code.
Temporary Service Agency
Name _________________________________________________ Phone #_______________________________
J.The out-of-state entity has no NYS employees and/or NYS subcontractors AND ALL work related to the permit, license or contract is done outside of NYS; OR ALL employees are direct employees of a government entity outside of New York. Please provide coverage information.
Carrier______________________________________Policy #__________________________________________
Policy start date _____________________________Policy expiration date ________________________________
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8.Please select the reason that the legal entity is NOT required to obtain New York State Statutory Disability Benefits Insurance Coverage:
A.The applicant is NOT applying for a disability benefits exemption and will show a separate certificate of NYS statutory disability benefits insurance coverage.
B.The business MUST be either: 1) owned by one individual; OR 2) is a partnership (including LLC, LLP, PLLP, RLLP, or LP) under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition, the business does not require disability benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability Benefits Law.)
C.The applicant is a political subdivision that is legally exempt from providing statutory disability benefits coverage.
D.The applicant is a nonprofit (under IRS rules) with NO compensated individuals providing services except for
clergy; or is a religious, charitable or educational nonprofit (Section 501(c)(3) under the IRS tax code) with no compensated individuals providing services except for executive officers, clergy, sextons, teachers or professionals.
E.The business is a farm and all employees are farm laborers.
F.The applicant is a homeowner serving as the general contractor for his/her primary/secondary personal residence. The homeowner has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability Benefits Law.)
□G. Other than the business owner(s) and individuals obtained from the temporary service agency, there are no other employees. Other than the business owner(s), all individuals providing services to the business are obtained from a temporary service agency and that agency has covered these individuals for New York State disability benefits insurance. In addition, the business is owned by one individual or is a partnership under the laws of New York State and is not a corporation; or is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (in a two person owned corporation, each individual must be an officer and own at least one share of stock). A Temporary Service Agency is a business that is classified as a temporary service agency under the business’s North American Industrial Classification System (NAICS) code.
9.I affirm that due to my position with the above-named business I have the knowledge, information and legal authority to make this Application for Certificate of Attestation of Exemption. I hereby affirm that the information provided above is true and that I have not submitted any materially false statements and I make this application for a Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement, representation, or concealment will subject me to felony prosecution, including jail and civil liability in accordance with the Workers’ Compensation Law and all other New York State Laws.
Signature
Title
Date
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STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
BUREAU OF COMPLIANCE
100BROADWAY ALBANY. NY 12241-0005
THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION.
Attached is an application for a certificate of attestation of exemption from New York State Workers' Compensation and/or Disability Benefits insurance coverage.
A certificate of attestation of exemption can ONLY be used to attest to a government entity that the applicant requesting a permit, license or contract from that government entity is not required to carry workers' compensation and/or disability benefits insurance.
Please carefully review the instructions before completing the application.
Exemption Application Instructions:
This application must be completed in its entirety and submitted to the Workers' Compensation Board by mailor fax. The application will be processed in the order received and a certificate of attestation of exemption will be mailed to the applicant. This process may take up to four weeks to complete.
For those who require an exemption immediately, please access the on-line application that can be found on the Board'swebsite, www.wcb.state.nv.us. Click the "WCIDB Exemption" button on the Board's mainwebpage and then click on "Request for WCIDB Exemption (Form CE-200)." You will be able to immediately print the certificate of attestation of exemption after completing the on-line application.
Instructions:
1.Applicant Personal Information: Enter the name (first and last), address and phone number. The applicant must have the knowledge, information and legal authority to file the application. An accountant or lawyer may not file the application on behalf of a client. The applicant will also be required to sign the certificate of attestation of exemption prior to filing it with the government entity.
2.Your title: Title refers to the position held by the applicant. Example: Sole Proprietor, Partner, Member, President, Secretary, Treasurer.
3.Legal Entity Information: Enter Federal ID number used for tax purposes. If the entity does not have a Federal
ID number, enter your social security number. Legal Entity is the business's legally filed name with the Department of State or County Clerk. Example: Corporation (ABC, Inc.) or LLC name ( XYZ, LLC). If this does not apply, enter the applicant's name. Doing business as refersto trade name or the name the business is known by.
4.Permit/License/Contract Information: Nature of business refers to what type of work is being performed. Enter the type of permit, license or contract for which you are applying. Examples: Building permit, health permit, liquor license. Issuing Government Agency is the agency to which you will give the certificate. Examples: City of Albany,
(Continued on reverse)
When preparing to submit a CE-200 form, applicants are navigating a critical process to establish their exemption from mandatory New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This exemption is pertinent for entities either without employees or operating under specific conditions out-of-state. Successfully completing this form is the initial step in attesting to governmental bodies that the requirement to carry said insurances does not apply, facilitating the acquisition of permits, licenses, or contracts. Below is a detailed guide on how to fill out this form correctly, ensuring clarity and compliance with New York State regulations.
Once completed, ensure that you review the form carefully. Misinformation or inaccuracies can lead to delays or legal complications. Submit the application as directed—either by fax or mail, following the instructions provided. By adhering to these steps, applicants efficiently navigate the exemption process, edging closer to their business objectives while in full compliance with New York State regulations.
The CE-200 form, known officially as the Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage, is a document designed for entities operating within specific parameters in New York State (NYS). It serves entities that either have no employees or are out-of-state entities securing contracts executed entirely outside of NYS for workers' compensation exemption. For disability benefits exemption, it is meant for entities with no employees or those with employees in NYS for fewer than thirty calendar days a year. Essentially, this certificate asserts to government entities that the applicant is exempt from mandatory workers' compensation and/or disability benefits insurance coverage when seeking permits, licenses, or contracts.
Eligibility to file the CE-200 form is limited to particular entities under distinct conditions. For exemption from workers' compensation insurance, applicable entities include those without employees or out-of-state entities engaging in contractual work fully outside of NYS. For exemption from disability benefits insurance, entities without employees or those with employees operating in NYS for less than thirty days within a year qualify. These constraints ensure that only businesses that genuinely do not require compulsory insurance due to the nature of their operations or workforce composition utilize this exemption.
To submit the CE-200 form, entities have two options. They can either mail or fax the completed form directly to the Workers' Compensation Board. The processing time for submissions can take up to four weeks. However, for those needing immediate exemption certification, the New York State Workers' Compensation Board offers an online application process at www.wcb.state.ny.us. Upon completing the online application, the certificate of attestation of exemption can be printed directly. It's important to fill out the application in its entirety to avoid delays in processing.
Completing the CE-200 form requires several pieces of information about the applicant and the entity seeking exemption. This includes:
It is critical the application is filled out accurately and thoroughly to ensure proper processing and verification.
Submitting false information on the CE-200 form is considered a serious offense and is subject to legal penalties. Individuals affirming false information may face felony charges, including possible jail time, and civil liabilities under the Workers’ Compensation Law as well as other New York State Laws. The attestation made in the CE-200 application is done under the penalties of perjury, underscoring the importance of providing truthful and accurate information throughout the process.
Filling out the CE-200 form, officially titled the New York State Workers’ Compensation Board Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage, can be quite challenging. It requires accurate and comprehensive information to ensure eligibility for exemption. However, a number of common mistakes can occur during this process:
Understanding and avoiding these common mistakes can help streamline the process of applying for an exemption, ensuring a smoother interaction with the New York State Workers' Compensation Board.
Filing the CE-200 form, which serves as an application for a Certificate of Attestation of Exemption from New York State Workers' Compensation and/or Disability Benefits Insurance Coverage, is just one step in a broader process for those seeking permits, licenses, or contracts that exempt them from mandatory insurance coverage in specific situations. Often, this form is accompanied by other crucial documents necessary to ensure compliance and facilitate the desired legal process. Below is a list of documents commonly required alongside the CE-200 form:
Each of these documents complements the information provided in the CE-200 form and serves unique purposes in the application process. Their requirement varies based on the specific needs of the issuing government entity and the legal or operational structure of the applicant's business. Understanding the function of each can greatly streamline the process of applying for and obtaining the necessary legal documents for business operations within New York State.
Form WC-Exempt: This document is for businesses seeking exemption from standard workers' compensation insurance requirements due to having no employees. Like the CE-200 form, it serves a similar purpose of attesting to exemption status, aiming to simplify regulatory compliance for small businesses or sole proprietors.
DB-155 Form: This form is specifically designed for businesses seeking exemption from disability benefits insurance in New York State. It parallels the CE-200 form in that entities eligible for this exemption meet criteria similar to those exempt from workers' compensation and/or disability benefits insurance coverage.
Form DTF-17: Used to register for a New York State sales tax certificate of authority. While principally different in its purpose—registering for tax collection rather than insurance exemption—it resembles the CE-200 in its structural requirement for detailed business information, including legal entity and personal identification specifics.
LLC-1 Form (Articles of Organization): Required for establishing a limited liability company in New York State. This form and the CE-200 share the requirement of providing detailed descriptions of the business, including the nature of the business and principle locations of operation, albeit for differing end purposes.
IT-2104 Form (Employee's Withholding Allowance Certificate): Though primarily for employee tax withholding, similarities to the CE-200 form include the necessity for businesses to understand and document the nuances of their workforce's structure and compensation, especially concerning exemptions.
U-26.3 Form: A New York State public works project exclusion form, resembling the CE-200 in its specificity for exemption from certain requirements. Entities applying must provide detailed reasons why they should be excluded, paralleling the exemption criteria detailed in the CE-200 form.
BPSS-1 Form: Application for licensure for private schools in New York. Similar to the CE-200, this form requires entities to furnish comprehensive business details, including ownership structure and operation nature, to meet regulatory approval for exemption in specific areas.
BI-472 Form: Building inspection application, necessary for construction or renovation projects. While its scope is more narrowed, it requires applicants to provide information on the project's specifics, similar to the CE-200's need for detailed job site and entity information when applying for exemptions within construction-related permits.
When filling out the CE200 form for the New York State Workers' Compensation Board, attention to detail and understanding the specific requirements are critical. Below are some general guidelines that can help ensure the process is smooth and successful.
Following these guidelines can help ensure that your CE200 form is accurately and efficiently processed, moving you one step closer to obtaining your certificate of attestation of exemption.
When it comes to filling out the CE-200 form, there are a number of misconceptions that can trip applicants up. Let’s clear up some of the most common misunderstandings:
The CE-200 form is only for construction businesses. This is incorrect. The CE-200 application is intended for any business or entity that seeks an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance coverage. This includes, but is not limited to, entities like restaurants, farms, trucking businesses, and even homeowners acting as their own general contractors.
Once you obtain a CE-200, you are exempt from all insurance requirements. This is not accurate. The CE-200 provides an attestation of exemption specifically for Workers’ Compensation and/or Disability Benefits Insurance for certain qualifications and conditions. It does not exempt an entity from other insurance requirements that may be applicable to the business operation.
All businesses can apply for a CE-200. Not true. To be eligible for a CE-200, a business must either have no employees, or, in specific cases like out-of-state entities, all work must be performed outside of New York State. There are also stipulations for businesses applying for a NYS disability benefits exemption.
Filing the CE-200 form is complicated. While any governmental form can be daunting, the CE-200 application process is straightforward if you follow the provided instructions. The application must be completed in full and can be submitted by fax or mail. For immediate needs, an online application that allows immediate printing of the certificate is available.
Approval of the CE-200 is automatic. This is incorrect. The Workers’ Compensation Board reviews applications in the order they are received. Processing may take up to four weeks, and there is no guarantee of approval. The application must meet all requirements for an exemption to be granted.
The CE-200 covers all officers and partners of a business. Misconception. The CE-200 applies based on the specific conditions under which the entity is claiming an exemption. It requires that all eligible officers, partners, or members be listed and meet the criteria for exemption.
Obtaining a CE-200 exempts you from auditing. Not true. Even with a CE-200 certificate, entities may still be subject to audit or investigation by the New York State Workers’ Compensation Board or other state agencies to ensure compliance with all relevant laws and regulations.
Understanding these misconceptions about the CE-200 form can help businesses and individuals navigate the application process more effectively, ensuring all legal obligations are met regarding workers' compensation and disability benefits in New York State.
Filling out the CE-200 form is a critical step for businesses and sole proprietors in New York State to claim exemption from workers' compensation and/or disability benefits insurance under specific conditions. The information provided in this application is pivotal to ensuring that you or your business are recognized as exempt under the law. Here are seven key takeaways to remember when completing and using this form:
Understanding these key aspects of the CE-200 form ensures that applicants can confidently navigate the exemption process, maintaining compliance with New York State laws and regulations while conducting their business operations.
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