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The CE200 form serves as an important application for those seeking a Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This form is specifically designed for entities that either have no employees or are out-of-state entities engaged in contracts where all work is performed outside of New York State. For those seeking exemption from disability benefits, the criteria are slightly different; it applies to businesses without employees or those with employees working in New York for less than thirty days in a calendar year. The certificate is particularly vital when dealing with government entities, as it certifies that the applicant is not required to carry workers' compensation or disability benefits insurance. To complete the application, all sections must be filled out accurately and submitted to the Workers’ Compensation Board via fax or mail. Processing can take up to four weeks, but an expedited option is available through an online application, allowing applicants to print their certificate immediately. Prior to filling out the form, it is essential to review the accompanying instructions to ensure clarity and compliance with the requirements.
Preview - Ce200 Form
New York State Workers' Compensation Board
Application for Certificate of Attestation of Exemption
from New York State Workers’ Compensation and/or
Disability and Paid Family Leave Benefits Insurance Coverage.
For NYS workers’ compensation exemption, this application may only be completed by entities with no employees or
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 and paid family leave 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
Please review the separate instructions (form
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: ( _______
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:_____________________
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Country (If other than U.S.) __________________________________________________________________
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 |
Homeowner |
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, and 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
Name: ________________________________________ |
Title: _____________________________________ |
Name: ________________________________________ |
Title: _____________________________________ |
Name: ________________________________________ |
Title: _____________________________________ |
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,
□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,
□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,
□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,
□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 ONLY has uncompensated friends and family working on his/her residence or is hiring individuals a total of less than 40 aggregate hours per week and has a current homeowner’s insurance policy that covers the property.
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,
Temporary Service Agency
Name _________________________________________________ Phone #_______________________________
J.The
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 and/or Paid Family Benefits Insurance Coverage:
□A. The applicant is NOT applying for a disability and paid family 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 and paid family leave 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 and Paid Family Leave Benefits Law.)
C.The applicant is a political subdivision that is legally exempt from providing statutory disability and/or paid
family leave 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 and Paid Family Leave 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 and paid family leave 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
Signature |
Title |
Date |
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Document Specifics
| Fact Name | Description |
|---|---|
| Form Purpose | The CE-200 form is used to apply for a Certificate of Attestation of Exemption from New York State Workers' Compensation and/or Disability Benefits Insurance Coverage. |
| Eligibility Criteria | This application can only be completed by entities with no employees or out-of-state entities performing all work outside of New York State. |
| Disability Benefits Exemption | Entities without employees or those with employees working in New York for less than thirty days in a calendar year can apply for a disability benefits exemption. |
| Usage of Certificate | The certificate can only be used to attest to a government entity that the applicant is not required to carry workers’ compensation and/or disability benefits insurance. |
| Application Submission | The completed application must be submitted to the Workers’ Compensation Board by fax or mail. |
| Processing Time | The application will be processed in the order it is received, and it may take up to four weeks to receive the certificate. |
| Online Application | For immediate processing, applicants can use the online application available at www.wcb.state.ny.us, allowing them to print the certificate right away. |
| Legal Compliance | Applicants must affirm that the information provided is true and that they have the legal authority to make the application. |
| Governing Laws | The CE-200 form is governed by New York State Workers' Compensation Law and New York State Disability Benefits Law. |
| Instructions Importance | It is crucial to review the separate instructions (form CE-200 instructions) before completing the application to ensure accuracy. |
Ce200: Usage Instruction
To complete the CE-200 form, you will need to provide specific information about yourself and your business. Once you have filled out the form, it must be submitted to the Workers’ Compensation Board by either fax or mail. The processing of your application may take up to four weeks, so please ensure that all information is accurate and complete to avoid delays.
- Applicant Personal Information: Fill in your first name, last name, street address, city, state, zip code, and country (if applicable). Include your personal phone number.
- Your Title: Select one title that best describes your position (e.g., Sole Proprietor, President, Member, etc.).
- Legal Entity Information: Provide your business's Federal ID number. If you do not have one, enter your social security number. Fill in the legal entity name and the doing business as name. Also, include your business phone number and email address. If your business address is the same as your personal address, check the box provided. If different, enter the business address details.
- Permit/License/Contract Information: Indicate the nature of your business by checking one option. Specify what you are applying for (license, permit, or contract) and name the issuing government agency.
- Job Site Location Information: If applicable, provide the job site address, city, state, zip code, and county. Include the project dates and the estimated dollar amount of the project.
- Partners/Members/Corporate Officers: List all partners, members, or corporate officers with their titles. Sole proprietors can skip this section.
- Workers’ Compensation Insurance Coverage: Select the reason why your legal entity is not required to obtain New York State Workers’ Compensation Insurance Coverage.
- Disability Benefits Insurance Coverage: Select the reason why your legal entity is not required to obtain New York State Statutory Disability Benefits Insurance Coverage.
- Affirmation: Sign and date the application, affirming the truthfulness of the information provided and your authority to make this application.
Learn More on Ce200
What is the CE-200 form?
The CE-200 form is an application for a Certificate of Attestation of Exemption from New York State Workers' Compensation and/or Disability Benefits Insurance Coverage. This form is specifically designed for entities that do not have employees or for out-of-state entities that perform all work outside of New York State. It allows applicants to certify to government entities that they are not required to carry these types of insurance.
Who is eligible to complete the CE-200 form?
Eligibility for completing the CE-200 form varies based on the type of exemption sought. For workers' compensation exemption, it can only be completed by:
- Entities with no employees.
- Out-of-state entities with contracts for work performed entirely outside of New York State.
For disability benefits exemption, eligible entities include those without employees or those with employees working in New York State for less than thirty days in a calendar year.
How do I submit the CE-200 form?
The CE-200 form must be completed in its entirety and submitted to the Workers' Compensation Board either by fax or mail. Ensure that all sections are filled out clearly. Once submitted, the application will be processed in the order received, and a certificate will be mailed to the applicant. This process may take up to four weeks. For immediate processing, applicants can use the online application available at www.wcb.state.ny.us .
What information is required on the CE-200 form?
Applicants must provide personal information, including:
- First and last name.
- Address and phone number.
- Title (e.g., Sole Proprietor, President).
- Legal entity information, including Federal ID or Social Security number.
- Nature of business and details about the permit, license, or contract being applied for.
It is essential to print clearly and review the instructions before completing the application.
What happens after I submit the CE-200 form?
After submission, the Workers' Compensation Board will process the application and mail the Certificate of Attestation of Exemption to the applicant. This process typically takes up to four weeks. If you require the certificate immediately, using the online application is recommended, as it allows for instant printing of the certificate upon completion.
Common mistakes
Filling out the CE200 form can be a straightforward process, but many make common mistakes that can delay their application. One frequent error is not providing complete personal information. Ensure that every field, such as your first name, last name, and contact details, is filled out accurately. Missing information can lead to processing delays.
Another common mistake is failing to select the correct title. Applicants often overlook this step, which can lead to confusion about the applicant's authority. Make sure to check only one title that accurately reflects your position within the entity.
Many applicants also forget to provide the correct legal entity information. This includes the business Federal ID number or social security number. If you do not have a Federal ID, clearly write your social security number. Omitting this information can result in a rejection of your application.
Not specifying the nature of the business is another mistake that applicants make. This section requires you to check only one box that describes your business type. Choose the option that best fits your situation to avoid complications.
Providing incomplete or unclear job site location information can also be problematic. If you are applying for a permit that requires a job site address, ensure that the street address, city, state, and zip code are all correctly filled out. Incomplete addresses can lead to delays in processing.
Another common error is not listing all partners or corporate officers when required. If you are not a sole proprietor, ensure that you include all relevant individuals and their titles. This step is crucial for compliance and may affect the validity of your application.
Some applicants misunderstand the exemption reasons. Selecting the wrong reason for not needing workers' compensation or disability benefits can result in an application being denied. Carefully review the options and choose the one that accurately reflects your situation.
Additionally, failing to sign and date the application can be a critical oversight. This signature is necessary to affirm that the information provided is true. Without it, your application cannot be processed.
Lastly, many applicants do not review the instructions before submitting the form. It is essential to read the guidelines to ensure that you have completed everything correctly. This small step can save you time and frustration in the long run.
Documents used along the form
The CE-200 form is a crucial document for businesses seeking an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance coverage. However, it is often accompanied by other forms and documents that help clarify or support the application process. Below is a list of related forms that may be necessary or useful in conjunction with the CE-200 form.
- Form CE-200 Instructions: This document provides detailed guidance on how to properly fill out the CE-200 form. It outlines the required information, the application process, and important considerations to ensure compliance with New York State laws.
- Form C-105.2: This is the Certificate of Workers' Compensation Insurance. It serves as proof that a business has the necessary workers' compensation coverage, which may be required by certain government entities when applying for permits or contracts.
- Form DB-120.1: This is the Certificate of Disability Benefits Insurance. Similar to the C-105.2, this form provides evidence of compliance with New York State disability benefits insurance requirements, which can be necessary for certain applications.
- Form CE-300: This is the Application for Exemption from Workers' Compensation Insurance for Certain Types of Nonprofit Organizations. Nonprofits may need to use this form to demonstrate their specific exemption status when applying for permits or licenses.
- Form CE-230: This is the Application for Certificate of Attestation of Exemption from New York State Disability Benefits Insurance Coverage. It is specifically designed for those who are exempt from carrying disability benefits insurance and need to certify this exemption.
- Form C-105.1: This is the Certificate of Workers' Compensation Insurance for Employers. It is another version of proof of coverage that employers may need to submit along with their applications to demonstrate compliance with state laws.
- Form DB-155: This is the Notice of Compliance with the New York State Disability Benefits Law. It serves as proof that a business is compliant with disability benefits laws and may be required for certain applications.
- Form CE-200AP: This is the Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage for Limited Liability Companies (LLCs). It is tailored for LLCs seeking exemption and outlines specific requirements for this business structure.
- Form WCB-1: This is the Employer's Report of Work-Related Injury or Illness. While not directly related to the CE-200 form, it may be necessary for businesses to complete this report if they have employees and need to document any workplace incidents.
Each of these forms plays a role in ensuring that businesses comply with New York State regulations regarding workers' compensation and disability benefits. By understanding these documents, applicants can navigate the exemption process more effectively and ensure that they meet all necessary requirements.
Similar forms
The CE-200 form is similar to the IRS Form 4506-T, which is used to request a transcript of tax return information. Both documents require personal and business information from the applicant. The CE-200 serves as a certification of exemption from workers' compensation and disability benefits insurance, while the IRS form provides verification of tax status for various purposes, such as loan applications or financial aid. Each form necessitates careful completion and submission to the respective authority, ensuring that the applicant meets the necessary criteria for exemption or verification.
Another document that resembles the CE-200 form is the New York State Department of Labor’s Form NYS-45. This form is used to report employee wages and taxes withheld. Similar to the CE-200, it requires detailed information about the business and its employees. However, while the CE-200 is focused on exemptions from insurance coverage, the NYS-45 is used to comply with tax reporting obligations. Both forms play crucial roles in ensuring that businesses adhere to state regulations, albeit in different areas.
The New York State Tax Department's ST-120 form, which is a sales tax exemption certificate, shares similarities with the CE-200 form. Each form requires the applicant to provide identifying information and a justification for the exemption being requested. The ST-120 is used to claim exemption from sales tax for certain purchases, while the CE-200 certifies that a business is not required to carry specific insurance. Both documents serve to protect the rights of the applicant while ensuring compliance with state laws.
Additionally, the Form 1099-MISC is comparable to the CE-200 in that it requires detailed information about the payee and the nature of the payments made. This form is used to report payments made to independent contractors, similar to how the CE-200 is used to attest to exemptions for businesses without employees. Both forms require accurate information to avoid potential legal issues and ensure that the appropriate parties are recognized by the respective authorities.
The Certificate of Good Standing is another document akin to the CE-200 form. This certificate verifies that a business entity is compliant with state regulations and has met all necessary requirements to operate legally. Both documents require the business to provide identifying information and may be requested by government entities for various purposes. While the CE-200 focuses on insurance exemptions, the Certificate of Good Standing emphasizes the legal status of a business.
Form W-9, used to request taxpayer identification information, is also similar to the CE-200. Both forms require the applicant to disclose personal and business information. The W-9 is primarily used for tax purposes, allowing businesses to report payments made to individuals or entities. In contrast, the CE-200 is aimed at confirming exemption from insurance requirements. Each form serves a distinct purpose but shares the common goal of ensuring compliance with relevant regulations.
The Application for a Business License is another document that parallels the CE-200 form. Both applications require comprehensive information about the business and its owners. While the CE-200 is specifically for workers' compensation and disability insurance exemptions, the business license application is a broader request for permission to operate legally within a jurisdiction. Each process involves careful review by the respective authorities to ensure compliance with local laws.
Furthermore, the New York State Disability Benefits Law Exemption Application is similar to the CE-200. This document is specifically designed for businesses seeking exemption from disability benefits coverage. Both forms require detailed information about the business and its employees. While the CE-200 covers both workers' compensation and disability benefits, the exemption application focuses solely on disability benefits, highlighting the specific requirements that must be met for exemption.
Lastly, the Certificate of Insurance is akin to the CE-200 form in that it provides proof of coverage for specific insurance types. While the CE-200 certifies exemption from insurance requirements, the Certificate of Insurance confirms that a business holds the necessary insurance policies. Both documents are essential for businesses seeking to establish their compliance with state regulations and protect their interests in contractual agreements.
Dos and Don'ts
When filling out the CE-200 form for the New York State Workers' Compensation Board, there are specific actions to take and avoid. Here is a list of guidelines:
- Do ensure that you are eligible to apply for the exemption based on your business structure and employee status.
- Do complete the application in its entirety. Incomplete forms may delay processing.
- Do print clearly to avoid any misunderstandings regarding your information.
- Do submit the application via fax or mail to the Workers' Compensation Board.
- Do use the online application if you need the certificate immediately.
- Don't have someone else, like an accountant or lawyer, file the application on your behalf.
- Don't forget to sign the application. Your signature is required to validate the information provided.
- Don't leave any sections blank. Each part of the application must be filled out to ensure proper processing.
- Don't submit false information. Misrepresentation can lead to legal penalties.
Following these guidelines will help ensure that your application for a Certificate of Attestation of Exemption is processed smoothly and efficiently.
Misconceptions
Here are some common misconceptions about the CE-200 form, along with clarifications to help you understand its purpose and requirements.
- Only businesses with employees can apply for the CE-200 form. This is not true. The form can be completed by entities with no employees or out-of-state entities performing work entirely outside of New York State.
- The CE-200 form is only for workers' compensation exemptions. This misconception overlooks that the form can also be used for disability benefits insurance exemptions, depending on specific criteria.
- The application can be submitted online for immediate processing. While there is an online application option for immediate printing, the CE-200 form submitted by fax or mail may take up to four weeks for processing.
- Anyone can fill out the CE-200 form on behalf of a business. Only the applicant, who has the legal authority and knowledge about the business, can complete and sign the application. This means accountants or lawyers cannot submit it on behalf of a client.
- The CE-200 form guarantees that an exemption will be granted. Completing the form does not guarantee approval. The application must meet specific criteria, and the Workers' Compensation Board will evaluate it accordingly.
- All businesses can use the CE-200 form regardless of their structure. The form is specifically designed for certain legal entities, such as sole proprietorships, partnerships, and specific types of corporations. Not all business structures qualify.
- Once submitted, the application can be modified or canceled easily. Changes to the application may not be straightforward. It is crucial to ensure all information is accurate before submission to avoid complications.
- The CE-200 form is only relevant for construction businesses. This is a misconception. The form applies to various industries, including but not limited to food service, landscaping, and trucking, as long as they meet the exemption criteria.
Key takeaways
Here are key takeaways regarding the CE200 form, which is essential for obtaining a Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage:
- The CE200 form is specifically for entities without employees or out-of-state entities performing work entirely outside of New York State.
- It can also be completed by entities with employees working in New York for less than thirty days in a calendar year.
- This application is only valid for attesting to government entities that an applicant is not required to carry insurance.
- Complete the application fully and ensure all sections are filled out accurately.
- Submit the application to the Workers’ Compensation Board via fax or mail.
- Processing may take up to four weeks, so plan accordingly if you need the certificate quickly.
- An online application option is available for immediate processing at www.wcb.state.ny.us.
- Review the accompanying instructions (form CE-200 instructions) carefully before completing the application.
- Print clearly to avoid any delays or misunderstandings in processing your application.
- Ensure that the applicant has the legal authority to file the application; an accountant or lawyer cannot submit it on behalf of the client.