Article Guide
The CE-200 form serves as an essential application for individuals and entities seeking a Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This application is specifically designed for those who do not have employees or for out-of-state entities that will perform all contracted work outside of New York State. In particular, the form addresses two primary exemptions: one from workers' compensation insurance and the other from disability benefits insurance. For the workers' compensation exemption, it is crucial that the applicant either has no employees or fits specific criteria, such as being an out-of-state entity. Similarly, the disability benefits exemption applies to entities with no employees or those with employees working in New York for less than thirty days in a calendar year. Importantly, the certificate can only be used to confirm to a government entity that the applicant is not required to carry the specified insurance coverage when applying for permits, licenses, or contracts. The completion of the CE-200 form necessitates careful attention to detail, requiring the applicant's personal and business information, as well as the nature of the business and the specific government agency involved. After submission, the application will be processed in the order it is received, with a potential processing time of up to four weeks. However, for those in urgent need of the exemption, an online application is available, allowing for immediate printing of the certificate upon completion. As applicants embark on this process, it is imperative to review the accompanying instructions thoroughly to ensure accurate completion and submission.
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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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Form Specifications
| Fact Name | Description |
|---|---|
| Form Purpose | The CE200 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 | Entities with no employees or out-of-state entities performing all work outside of New York State can complete this application for workers’ compensation exemption. |
| Disability Benefits Exemption | Entities without employees, or those with employees working in New York for less than thirty days in a calendar year, may apply for a disability benefits exemption. |
| Application Submission | The completed application must be submitted to the Workers’ Compensation Board by fax or mail. Processing may take up to four weeks. |
| Immediate Certificate Access | Applicants can use the online application at www.wcb.state.ny.us for immediate access to the certificate after completion. |
| Governing Law | This form is governed by the New York State Workers' Compensation Law and the New York State Disability Benefits Law. |
Ce200: Usage Guidelines
Completing the CE-200 form is an important step for those seeking an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This application must be filled out accurately and submitted to the Workers’ Compensation Board for processing. Once submitted, you can expect to receive a certificate of attestation of exemption by mail, which may take up to four weeks. If you need the certificate more quickly, consider using the online application available on the Board's website.
- 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: Check the box that corresponds to your title, such as Sole Proprietor, President, or other relevant title.
- Legal Entity Information: Provide the Business Federal ID or social security number if there is no Federal ID. Enter the legal entity name and any "Doing Business As" name. Include the business phone number and email address. If the business address is the same as your personal address, check the appropriate box; otherwise, enter the business address details.
- Permit/License/Contract Information: Indicate the nature of your business by checking the appropriate box. Specify what type of permit, license, or contract you are applying for, along with the name of the issuing government agency.
- Job Site Location Information: If applicable, provide the job site address, including city, state, zip code, and county. Include the project dates and 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 Reason: Select the reason your legal entity does not require New York State Workers’ Compensation Insurance Coverage by checking the appropriate box.
- Disability Benefits Insurance Coverage Reason: Choose the reason your legal entity does not require New York State Statutory Disability Benefits Insurance Coverage by checking the appropriate box.
- Affirmation: Sign the application, providing your title and the date. Ensure that you affirm the accuracy of the information provided.
Your Questions, Answered
What is the CE200 form?
The CE200 form is an application used in New York State to request a Certificate of Attestation of Exemption from Workers' Compensation and/or Disability Benefits Insurance Coverage. This form is specifically for entities that do not have employees or for out-of-state entities whose work is performed entirely outside of New York State.
Who can complete the CE200 form?
This application can only be completed by entities with no employees or those with employees who work in New York State for less than thirty days in a calendar year. It is crucial that the applicant has the authority to file the application, meaning they should be an owner or an authorized representative of the business.
What is the purpose of the Certificate of Attestation of Exemption?
The certificate serves to inform government entities that the applicant is not required to carry workers' compensation and/or disability benefits insurance. This is often necessary when applying for permits, licenses, or contracts from government agencies.
How should the CE200 form be submitted?
The completed CE200 form must be submitted to the New York State Workers' Compensation Board either by fax or mail. It is important to ensure that the application is filled out completely to avoid delays in processing.
How long does it take to process the CE200 application?
The processing time for the CE200 application can take up to four weeks. If immediate certification is needed, applicants can use the online application available on the Workers' Compensation Board's website, allowing them to print the certificate right away.
What information is required on the CE200 form?
Applicants must provide personal information such as their name, address, and phone number. Additionally, details about the legal entity, including its Federal ID number or Social Security number, and the nature of the business must be included. Specific information about the permit, license, or contract being applied for is also necessary.
Can a representative submit the CE200 form on behalf of the applicant?
No, the CE200 form must be submitted by the applicant themselves. An accountant or lawyer cannot file the application on behalf of a client. The applicant must have the knowledge and legal authority to complete the form.
What happens if the information provided on the CE200 form is false?
Providing false information on the CE200 form can lead to serious consequences, including felony prosecution and civil liability. It is essential that all information submitted is accurate and truthful, as the applicant is affirming their understanding of the penalties for misrepresentation.
Where can I find additional instructions for completing the CE200 form?
Separate instructions for completing the CE200 form are available and should be reviewed prior to filling out the application. These instructions provide valuable guidance on how to accurately complete the form and ensure that all necessary information is included.
Common mistakes
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Incomplete Personal Information: Many applicants forget to fill out all required fields, such as their full name, address, or phone number. Ensure that every section is completed accurately.
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Incorrect Title Selection: Selecting more than one title or failing to check a title can lead to confusion. Only one title should be marked clearly to avoid processing delays.
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Legal Entity Information Mistakes: Applicants often mix up their Federal ID number and social security number. It's crucial to provide the correct number based on the type of business entity.
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Nature of Business Errors: Choosing multiple options for the nature of the business instead of one can complicate the application. Make sure to select only the most applicable type of business.
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Missing Job Site Information: If applying for specific permits, failing to include job site location details can result in a rejection. Always provide a complete address and relevant project dates.
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Incorrect Reason for Exemption: Applicants sometimes select the wrong reason for exemption under workers’ compensation or disability benefits. Review the options carefully to ensure the correct choice is made.
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Signature Issues: Not signing the application or failing to include the date can lead to immediate rejection. Always double-check that the application is signed and dated by the appropriate person.
Documents used along the form
The CE-200 form is an important document used in New York State for obtaining a Certificate of Attestation of Exemption from Workers' Compensation and/or Disability Benefits Insurance Coverage. Several other forms and documents are commonly used alongside the CE-200 to facilitate the application process and ensure compliance with state regulations. Below is a list of these documents, each accompanied by a brief description.
- CE-200 Instructions: This document provides detailed guidance on how to properly fill out the CE-200 form. It outlines the necessary information required from the applicant and offers tips to avoid common mistakes.
- WCB-1 Form: This is the Notice of Compliance form that employers must file to confirm their compliance with New York State Workers' Compensation Law. It serves as proof of insurance coverage.
- DB-120.1 Form: This form is used to apply for a certificate of insurance for Disability Benefits. It verifies that the business has the necessary coverage in place for its employees.
- WCB-2 Form: This form is a Notice of Claim that employees can use to report an injury or illness related to their work. It is essential for initiating a claim under the Workers' Compensation program.
- DB-300 Form: This is the Disability Benefits Insurance form that employers must complete to demonstrate compliance with the Disability Benefits Law. It ensures that employees are covered for short-term disabilities.
- WCB-3 Form: This form is used to report an employee's injury to the Workers' Compensation Board. It includes details about the injury, the employee, and the employer.
- CE-200AP Form: This application form is specifically for non-profit organizations seeking an exemption from Workers' Compensation and Disability Benefits insurance coverage. It outlines the criteria for eligibility.
- Form 1099-MISC: This tax form is used to report payments made to independent contractors. It is relevant for businesses that may not classify certain workers as employees.
- Employer's Guide to Workers' Compensation: This document offers an overview of the responsibilities and rights of employers under New York State law regarding Workers' Compensation coverage.
- Certificate of Insurance: This document serves as proof of insurance coverage and is often required by government entities when applying for permits or licenses.
Understanding these documents and their purposes can significantly streamline the process of obtaining the necessary exemptions and compliance certifications in New York State. Proper preparation and submission of these forms are crucial for ensuring that businesses operate within legal requirements and protect themselves from potential liabilities.
Similar forms
- WCB Form C-105.2: This form is used to provide proof of workers' compensation insurance coverage. Similar to the CE-200, it is a requirement for contractors and businesses applying for permits or licenses.
- WCB Form DB-120.1: This form serves as proof of disability benefits insurance coverage. Like the CE-200, it demonstrates compliance with New York State laws regarding employee benefits.
- WCB Form C-105.1: This is another proof of workers' compensation insurance form. It is similar to CE-200 in that it must be submitted when applying for certain permits or licenses.
- NYC Department of Buildings (DOB) Permit Application: This application requires proof of insurance coverage, akin to the CE-200, to ensure that contractors comply with local laws before commencing work.
- NY State Department of Labor (DOL) Application for Permit: This application also mandates proof of insurance coverage, similar to the CE-200, to protect workers and ensure compliance with state regulations.
- IRS Form SS-4: This form is used to apply for an Employer Identification Number (EIN). It is similar to the CE-200 in that it establishes the legal identity of a business for compliance purposes.
- NY State Business Certificate: This document is required for businesses operating under a fictitious name. Like the CE-200, it affirms the legitimacy of the business entity.
- NY State Sales Tax Certificate of Authority: This certificate allows businesses to collect sales tax. It is similar to the CE-200 in that it is essential for legal operation within New York State.
- NY State LLC Publication Requirement: This requirement mandates that newly formed LLCs publish their formation in local newspapers. Similar to the CE-200, it is a step in ensuring compliance with state regulations.
Dos and Don'ts
When filling out the CE-200 form, it's important to keep a few key points in mind. Here’s a list of things you should and shouldn't do:
- Do ensure all sections are completed fully. Incomplete forms can lead to delays.
- Do use clear and legible handwriting. This helps avoid misunderstandings.
- Do double-check the information provided. Accuracy is crucial.
- Do submit the form via the recommended methods. Mail or fax are acceptable.
- Do review the separate instructions before starting the application. They provide essential guidance.
- Don't let someone else fill out the form for you unless they are authorized. You must sign it.
- Don't skip any sections. Every part of the application is important.
- Don't forget to provide your contact information. This is vital for communication.
- Don't use unclear abbreviations or jargon. Stick to plain language.
- Don't assume your application will be processed immediately. It may take up to four weeks.
Misconceptions
Misconceptions about the CE200 form can lead to confusion and potentially hinder the application process. Here are nine common misconceptions clarified:
- Only businesses with employees can apply for the CE200 form. This is incorrect. The CE200 form can be completed by entities with no employees or out-of-state entities performing all work outside of New York State.
- The CE200 form is only for workers' compensation exemptions. This is a misunderstanding. The form can also be used for disability benefits exemptions, depending on specific criteria.
- Once submitted, the application will be processed immediately. In reality, processing can take up to four weeks. For quicker access, an online application is available.
- Any person can submit the application on behalf of the business. This is false. The applicant must have the legal authority and knowledge to file the application themselves.
- The CE200 form can be submitted electronically without prior completion. It must be filled out completely and accurately before submission, whether by mail or fax.
- Independent contractors count as employees for the purpose of the CE200 form. This is not true. Independent contractors are not considered employees under New York State laws regarding workers' compensation and disability benefits.
- Homeowners cannot apply for the CE200 form. In fact, homeowners serving as general contractors for their own residences can apply, provided they meet the necessary criteria.
- The CE200 form is only necessary for large businesses. This misconception overlooks that small businesses and even sole proprietors may need to complete the form based on their specific circumstances.
- Filing the CE200 form guarantees exemption from insurance requirements. The form merely attests to the exemption; it does not automatically exempt the applicant from all insurance obligations.
Understanding these misconceptions can help ensure that applicants complete the CE200 form correctly and efficiently. It is advisable to review the instructions thoroughly before proceeding with the application.
Key takeaways
Filling out and using the CE-200 form is an important process for entities seeking exemption from New York State Workers' Compensation and/or Disability Benefits Insurance Coverage. Here are seven key takeaways to consider:
- Eligibility Criteria: Only entities with no employees or out-of-state entities performing all work outside of New York State can apply for a workers' compensation exemption.
- Disability Benefits Exemption: Entities without employees or those with employees working in New York for less than thirty days in a calendar year may apply for a disability benefits exemption.
- Certificate Usage: The certificate of attestation of exemption can only be used to attest to a government entity that the applicant is not required to carry the specified insurance.
- Application Submission: Complete the application in its entirety and submit it to the Workers' Compensation Board by fax or mail for processing.
- Processing Time: The application will be processed in the order it is received and may take up to four weeks to complete.
- Online Application: For immediate certification, applicants can use the online application available on the Workers' Compensation Board website.
- Review Instructions: It is crucial to review the separate instructions (form CE-200 instructions) before completing the application to ensure accuracy and compliance.