Table of Contents
The CE-200 form is a crucial document for those seeking an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This application is specifically designed for entities without employees or out-of-state entities that will conduct all work outside of New York State. It allows applicants to certify to government entities that they are not required to carry workers’ compensation or disability benefits insurance. For instance, a sole proprietor with no employees or a homeowner acting as a general contractor may qualify for this exemption. The form requires detailed information, including personal and legal entity details, the nature of the business, and the specific permits or licenses being sought. Applicants must complete the form accurately and submit it to the Workers’ Compensation Board via fax or mail, with processing times potentially extending up to four weeks. However, an expedited option is available through an online application process, allowing for immediate printing of the exemption certificate. Understanding the requirements and completing the CE-200 form correctly is essential for ensuring compliance and avoiding unnecessary delays in obtaining necessary permits or contracts.
Sample - 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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File Specs
| 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 the form 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. |
| Use of Certificate | The certificate can only be used to attest to a government entity that the applicant is not required to carry the relevant insurance. |
| Submission Method | The completed application must be submitted to the Workers' Compensation Board via fax or mail. |
| Processing Time | Processing of the application may take up to four weeks, depending on the order received. |
| Online Application | An immediate certificate can be obtained by completing the online application at www.wcb.state.ny.us. |
| Instructions Review | Applicants must review the separate instructions (form CE-200 instructions) before completing the application. |
| Legal Authority | The applicant must have the knowledge and legal authority to file the application, as it cannot be submitted by an accountant or lawyer on behalf of a client. |
| Governing Law | The CE200 form is governed by New York State Workers' Compensation Law and New York State Disability Benefits Law. |
Ce200 - Usage Guidelines
Completing the CE-200 form is an essential step for those seeking an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. After filling out the form, it must be submitted to the Workers’ Compensation Board by either fax or mail. The processing time can take up to four weeks, but an online application is available for those needing immediate certification.
- 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 only one box that corresponds to your title, such as Sole Proprietor, President, or Other (if applicable, specify).
- Legal Entity Information: Enter your Business Federal ID or social security number if none exists. Fill in the Legal Entity Name and Doing Business As Name. Provide your business phone number and email. If your business address is the same as your personal address, check the box; otherwise, fill in the business street address, city, state, zip code, and country (if applicable).
- Permit/License/Contract Information: Select the nature of your business by checking one box, such as Construction or Restaurant. Specify what you are applying for: a license, permit, or contract, and include the name of the issuing government agency.
- Job Site Location Information: If applying for a building, plumbing, or electrical permit, provide the job site address, city, state, zip code, and county. Include the project dates and estimated dollar amount of the project.
- Partners/Members/Corporate Officers: List the names and titles of all partners or corporate officers, except for limited partnerships, which only require general partners. Sole proprietors can skip this section.
- Workers’ Compensation Insurance Coverage Reason: Select the reason your legal entity is not required to obtain New York State Workers’ Compensation Insurance Coverage by checking the appropriate box.
- Disability Benefits Insurance Coverage Reason: Similarly, select the reason your legal entity is not required to obtain New York State Statutory Disability Benefits Insurance Coverage by checking the appropriate box.
- Affirmation: Sign and date the application, affirming that the information provided is true and accurate.
Your Questions, Answered
What is the CE200 form used for?
The CE200 form is an application for a Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. It allows certain entities, particularly those without employees or those working outside of New York State, to certify that they are exempt from carrying these types of insurance.
Who can complete the CE200 form?
The form can be completed by entities with no employees, or out-of-state entities that are obtaining contracts for work performed entirely outside of New York State. Additionally, businesses with employees working in New York for less than thirty days in a calendar year may also apply for a disability benefits exemption.
How do I submit the CE200 form?
You must complete the application in its entirety and submit it to the Workers’ Compensation Board by either fax or mail. Ensure that you send it to the correct address to avoid delays. The processing time can take up to four weeks.
Can I apply for the CE200 form online?
Yes, if you need a certificate immediately, you can use the online application available at www.wcb.state.ny.us. After completing the online form, you can print the certificate right away.
What information is required on the CE200 form?
The form requires personal information, such as your name and contact details, as well as your title. You will also need to provide legal entity information, including your business name and Federal ID number, if applicable. Additionally, you must specify the nature of your business and the type of permit, license, or contract you are applying for.
What if I have questions while filling out the CE200 form?
If you have questions about specific sections of the form, it is recommended to contact an attorney. Employees of the Workers’ Compensation Board cannot assist with these inquiries.
What happens after I submit the CE200 form?
Once your application is submitted, it will be processed in the order received. If approved, a Certificate of Attestation of Exemption will be mailed to you. Keep in mind that this process can take several weeks, so plan accordingly.
Common mistakes
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Incomplete Personal Information: Applicants often fail to provide all required personal details, such as the full street address or phone number. This omission can delay processing.
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Incorrect Title Selection: Some applicants do not select the appropriate title from the provided options. Choosing the wrong title can lead to confusion about the applicant's authority.
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Failure to Specify Legal Entity: It is crucial to accurately enter the legal entity information. Mistakes in the Federal ID number or the legal entity name can result in rejection of the application.
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Neglecting Job Site Information: When applying for specific permits, applicants often overlook providing the job site address or relevant project dates. This information is essential for processing.
Documents used along the form
The CE-200 form is an essential document for entities seeking an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. When applying for this exemption, several other forms and documents may accompany the CE-200 to ensure a smooth application process. Below are five commonly used documents that may be required or helpful in conjunction with the CE-200 form.
- CE-200 Instructions: This document provides detailed guidance on how to complete the CE-200 form. It outlines the necessary information required from the applicant and clarifies the eligibility criteria for exemption.
- Certificate of Insurance: If an entity is not seeking an exemption but has existing workers’ compensation or disability benefits insurance, this certificate serves as proof of coverage. It is often required by government agencies when applying for permits or contracts.
- IRS Form W-9: This form is used to provide the taxpayer identification number and certification of the entity's tax status. Government agencies may request this form to verify the applicant’s identity and tax compliance.
- Business License: Depending on the nature of the business, a valid business license may be required. This document confirms that the business is legally authorized to operate in its respective industry and location.
- Partnership Agreement or Articles of Incorporation: For entities structured as partnerships or corporations, these documents outline the legal framework and ownership structure. They may be requested to verify the legitimacy and organization of the business.
When applying for a certificate of attestation of exemption, it is crucial to gather all necessary documents to facilitate the process. Each document serves a specific purpose and helps ensure compliance with New York State regulations. By being well-prepared, applicants can expedite their request and avoid potential delays.
Similar forms
The CE-200 form is similar to the IRS Form 1023, which is the Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code. Both documents serve as applications for exemption from certain obligations. While the CE-200 focuses on workers’ compensation and disability benefits insurance exemptions in New York State, Form 1023 is aimed at securing federal tax-exempt status for nonprofit organizations. Each form requires detailed information about the entity applying for exemption, including its structure and operations, ensuring that the applicant meets the necessary criteria for exemption.
Another document akin to the CE-200 is the Certificate of Good Standing. This certificate verifies that a business is legally registered and compliant with state regulations. Like the CE-200, it is often required when applying for permits, licenses, or contracts. Both documents affirm the legitimacy of the entity, providing assurance to government agencies or other organizations that the applicant is in good standing and free from certain liabilities, which in the case of the CE-200, pertains to workers' compensation and disability benefits.
The Small Business Administration's (SBA) Form 1919, which is used for applying for a Paycheck Protection Program (PPP) loan, shares similarities with the CE-200. Both forms require applicants to provide personal and business information, including details about ownership and operational structure. Each form aims to establish the applicant's eligibility for specific benefits or exemptions, thereby facilitating the process of obtaining financial or regulatory relief.
Form W-9, Request for Taxpayer Identification Number and Certification, is another document that bears resemblance to the CE-200. Both forms require the disclosure of identifying information about the applicant, such as the legal name and business structure. While the W-9 is primarily used for tax purposes, ensuring that the correct taxpayer identification is reported, the CE-200 serves to confirm exemption from certain insurance requirements, both providing necessary documentation for compliance in their respective areas.
The New York State Department of Labor’s Application for Unemployment Insurance (Form NYS-45) is also comparable to the CE-200. Both forms require detailed information about the business and its employees, establishing the entity's compliance with state laws. While the NYS-45 focuses on unemployment insurance, the CE-200 addresses workers’ compensation and disability benefits, highlighting the importance of proper documentation in navigating state regulations.
Form 1065, U.S. Return of Partnership Income, is another document that shares characteristics with the CE-200. Both forms require detailed information about the entity's structure and operations. Form 1065 is used by partnerships to report income, deductions, and other tax-related information, whereas the CE-200 is used to apply for exemptions from insurance coverage. Each form plays a vital role in ensuring compliance with respective regulatory requirements.
The Certificate of Liability Insurance is similar in function to the CE-200, as both documents serve to confirm an entity's compliance with insurance requirements. The Certificate of Liability Insurance provides proof of coverage for general liability, while the CE-200 certifies exemption from workers’ compensation and disability benefits insurance. Both are often required for contracts and permits, assuring stakeholders of the entity's risk management practices.
The New York State Business Certificate, also known as a DBA (Doing Business As) certificate, parallels the CE-200 in that both serve to establish the legitimacy of a business. The DBA certificate verifies that a business is operating under a name different from its legal name, while the CE-200 confirms exemption from certain insurance requirements. Both documents are crucial for businesses seeking to operate legally and transparently within New York State.
Lastly, the New York State Sales Tax Certificate of Authority is akin to the CE-200 in that both are essential for businesses operating in New York. The Sales Tax Certificate allows businesses to collect sales tax, while the CE-200 allows them to claim exemptions from workers’ compensation and disability benefits insurance. Each document is vital for compliance with state regulations and ensures that businesses can operate effectively without legal hindrances.
Dos and Don'ts
When filling out the CE-200 form for the New York State Workers' Compensation Board, there are important guidelines to follow. Here is a list of things you should and shouldn't do:
- Do read the instructions thoroughly before starting the application.
- Do ensure that all required fields are completed accurately.
- Do use clear, legible handwriting if filling out the form by hand.
- Do provide your legal entity name as it appears on official documents.
- Don't leave any sections blank; incomplete applications may be delayed.
- Don't submit the application without signing it; a signature is required.
- Don't use an accountant or lawyer to file the application on your behalf.
- Don't forget to check for any additional documents that may need to be attached.
Following these guidelines can help ensure a smoother application process and reduce the chances of delays in receiving your certificate of attestation of exemption.
Misconceptions
Misconceptions about the CE-200 form can lead to confusion and potential issues when applying for an exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. Here are nine common misconceptions:
- Only businesses with employees can apply for the CE-200 form. This is incorrect. The form can be completed by entities with no employees or out-of-state entities performing all work outside of New York State.
- The CE-200 form is only for large companies. In reality, any qualifying entity, regardless of size, can apply. Sole proprietors and small businesses often use this form.
- Once submitted, the CE-200 application is processed immediately. The processing can take up to four weeks. For immediate needs, applicants should consider the online application option.
- The CE-200 form is only for workers’ compensation exemptions. This form can also be used for exemptions from disability benefits insurance coverage, depending on the applicant’s circumstances.
- Applicants must have a lawyer to complete the CE-200 form. While legal advice can be helpful, applicants can complete the form themselves as long as they have the necessary knowledge and authority.
- The CE-200 form can be submitted online only. It can also be submitted by fax or mail, although online submission offers immediate printing of the certificate.
- All types of businesses can automatically qualify for an exemption. Specific criteria must be met, such as having no employees or being a certain type of legal entity.
- The CE-200 form is the same as a certificate of insurance. The form is an application for a certificate of attestation of exemption, not a certificate of insurance itself.
- Once granted, the exemption is permanent. Exemptions must be reviewed periodically, and changes in business structure or employee status can affect eligibility.
Key takeaways
Filling out the CE-200 form can seem daunting, but understanding its key aspects can make the process smoother. Here are five essential takeaways to keep in mind:
- Eligibility Matters: Only certain entities can apply for this exemption. If you have no employees or are an out-of-state entity performing all work outside of New York State, you may qualify for the workers' compensation exemption.
- Complete the Form: Ensure every section of the CE-200 form is filled out completely. Missing information can lead to delays in processing your application.
- Processing Time: After submitting your application, be prepared to wait. It can take up to four weeks for the Workers’ Compensation Board to process your request and send you the certificate.
- Online Option: If you need the exemption certificate quickly, consider using the online application. This allows you to complete the form and print the certificate immediately.
- Review Instructions: Before diving into the application, take a moment to read the accompanying instructions. Familiarizing yourself with the requirements can help prevent errors and streamline the process.
By keeping these points in mind, you can navigate the CE-200 form with confidence and clarity. Good luck!