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The CE200 form is an important application used in New York State for those seeking a Certificate of Attestation of Exemption from 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 performing all work outside New York. For disability benefits, the exemption applies to businesses without employees or those whose employees work in New York for less than thirty days in a calendar year. The certificate serves as proof to government entities that the applicant is not required to carry these insurances when applying for permits, licenses, or contracts. To complete the CE200 form, applicants must provide personal and business information, including the nature of their business and the specific permit or license they are applying for. The application must be submitted in full to the Workers’ Compensation Board via fax or mail, and processing can take up to four weeks. For quicker access, an online application is available, allowing applicants to print their certificate immediately upon completion. It is crucial to review the accompanying instructions carefully before filling out the form, ensuring that all information is accurate and clearly presented.

Ce200 Example

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 out-of-state entities obtaining contracts for which ALL work is performed outside of NYS. For NYS disability and paid family leave benefits exemption, it may only be completed by entities without employees or those with employees, as defined by the NYS Disability and Paid Family Leave 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 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 on-line application at www.businessexpress.ny.gov. 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:_____________________

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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 -must list all with titles except for limited partnerships which must include only general partners. Sole proprietors can skip this section.

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, 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 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, 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 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 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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File Breakdown

Fact Name Details
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 for Workers' Compensation Exemption This application can only be completed by entities with no employees or out-of-state entities with contracts for work performed entirely outside of New York State.
Eligibility for Disability Benefits Exemption Entities without employees, or those with employees working in New York State for less than thirty days in a calendar year, may apply for this exemption.
Usage of Certificate The certificate can only be used to attest to a government entity that the applicant is not required to carry the specified insurance.
Submission Method The application must be submitted to the Workers’ Compensation Board by fax or mail, and it must be completed in its entirety.
Processing Time The application will be processed in the order it is received, which may take up to four weeks.
Online Application For immediate certification, applicants can use the online application available at www.wcb.state.ny.us.
Instructions Review Applicants are advised to review the separate instructions (form CE-200 instructions) before completing the application.
Legal Authority The applicant must have the knowledge and authority to make the application, and must affirm the truthfulness of the information provided.

Guide to Using Ce200

To successfully complete the CE-200 form, follow these steps carefully. Ensure that all information is accurate and clearly printed. After completing the form, submit it to the Workers' Compensation Board by fax or mail. The processing time can take up to four weeks. If immediate certification is required, consider using the online application available on the Board's website.

  1. Applicant Personal Information: Fill in your first name, last name, street address, city, state, zip code, country (if applicable), and personal phone number.
  2. Your Title: Check only one box that corresponds to your position, such as Sole Proprietor, Treasurer, President, etc.
  3. Legal Entity Information: Provide your business federal ID or social security number, legal entity name, and doing business as name. Include your business phone number and email. If the business address is the same as your personal address, check the appropriate box. If different, enter the business address, city, state, zip code, and country.
  4. Permit/License/Contract Information: Indicate the nature of your business by checking one box from the list provided. Specify the type of license, permit, or contract you are applying for, along with the issuing government agency.
  5. Job Site Location Information: If applicable, provide the job site address, city, state, zip code, and county. Include the project dates and estimated dollar amount of the project.
  6. Partners/Members/Corporate Officers: List all partners, members, or corporate officers with their titles, unless you are a sole proprietor.
  7. Reason for Workers’ Compensation Exemption: Select the appropriate reason for not needing New York State Workers’ Compensation Insurance coverage by checking the corresponding box.
  8. Reason for Disability Benefits Exemption: Select the appropriate reason for not needing New York State Disability Benefits Insurance coverage by checking the corresponding box.
  9. Affirmation: Sign and date the application, affirming that the information provided is true and complete.

Get Answers on Ce200

What is the CE-200 form used for?

The CE-200 form is the Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. It is specifically designed for entities that do not have employees or for out-of-state entities that are entering contracts for work performed entirely outside of New York State. This certificate can only be used to inform a government entity that the applicant does not need to carry workers’ compensation or disability benefits insurance.

Who can complete the CE-200 form?

Only certain entities can complete this application. For workers’ compensation exemption, it may be filled out by entities without employees or out-of-state entities with contracts where all work occurs outside of New York State. For disability benefits exemption, it may be completed by entities without employees or those with employees working in New York State for less than thirty days in a calendar year. The applicant must also have the authority to file the application, meaning they cannot have someone else, like an accountant or lawyer, submit it on their behalf.

How do I submit the CE-200 form?

The completed CE-200 form must be submitted to the Workers’ Compensation Board either by fax or mail. It is important to fill out the application completely. Once submitted, the application will be processed in the order it is received, and the certificate will be mailed to the applicant. This process can take up to four weeks. For immediate needs, applicants can use the online application available on the Workers’ Compensation Board's website, where they can print the certificate right after completion.

What information is required on the CE-200 form?

The CE-200 form requires various pieces of information, including:

  1. Applicant personal information such as name, address, and phone number.
  2. Title of the applicant, like Sole Proprietor or President.
  3. Legal entity information, including Federal ID or Social Security number and the legal name of the business.
  4. Details about the nature of the business and the type of permit, license, or contract being applied for.
  5. Job site location information if applicable, including the address and dates of the project.

Completing all sections accurately is crucial for the processing of the application.

Common mistakes

Filling out the CE-200 form can be a straightforward process, but many people make mistakes that can delay their application. One common error is failing to complete all required sections. Each part of the form is crucial for the Workers’ Compensation Board to process your request efficiently. Leaving any section blank can lead to unnecessary delays.

Another frequent mistake is not providing accurate contact information. It’s essential to double-check that your personal phone number and email address are correct. If the board needs to reach you for clarification or additional information, incorrect details can hinder communication and slow down the process.

Many applicants also overlook the importance of selecting the correct title. The title should accurately reflect your role within the business. This may seem minor, but it helps establish your authority to submit the application. Choosing the wrong title can lead to questions about the legitimacy of the application.

Some individuals mistakenly assume that they can submit the application on behalf of someone else. Only the applicant who has the legal authority to make the application should sign it. This means that if you are not the owner or authorized representative, you cannot submit the form for someone else.

Another common oversight is misunderstanding the exemption criteria. The CE-200 form is specific about who qualifies for exemptions from workers’ compensation and disability benefits insurance. Make sure to read these requirements carefully. If you do not meet the criteria, your application may be denied.

Additionally, people sometimes fail to attach necessary documentation. If your business structure requires additional proof, such as a Federal ID number or proof of exemption status, ensure that these documents are included with your application. Missing paperwork can result in delays or rejection.

Some applicants also forget to sign the application. The signature is a critical part of the process, affirming that the information provided is accurate. Without a signature, the application cannot be processed.

Lastly, many people do not take the time to review the instructions provided with the CE-200 form. These instructions contain vital information that can help you avoid mistakes. Taking a few moments to read through them can save you time and frustration in the long run.

Documents used along the form

The CE-200 form is an important document for those seeking exemption from New York State Workers’ Compensation and/or Disability Benefits insurance coverage. However, several other forms and documents are often used in conjunction with the CE-200. Understanding these can help streamline the application process and ensure compliance with state regulations.

  • CE-200 Instructions: This document provides detailed guidance on how to complete the CE-200 form. It outlines the necessary information and steps required to successfully submit the application.
  • Certificate of Insurance: This certificate proves that a business has valid workers’ compensation and disability benefits insurance. It may be required when applying for certain permits or contracts.
  • DB-120.1: This form is used to request a waiver for New York State Disability Benefits insurance. It is often needed for businesses that do not meet the typical coverage requirements.
  • WCB Form C-105.2: This is a certificate of insurance that provides proof of coverage for workers’ compensation insurance. It is essential for businesses that do have employees.
  • WCB Form DB-120: Similar to the C-105.2, this form serves as proof of statutory disability benefits coverage. It is required for businesses with employees in New York State.
  • Business License Application: This document is often required for businesses seeking to operate legally in their respective industries. It may need to be submitted alongside the CE-200 form.
  • Partnership Agreement: If the business is a partnership, this document outlines the roles and responsibilities of each partner. It may be necessary to provide clarity on the business structure when applying for exemptions.

By being familiar with these additional forms and documents, applicants can better navigate the exemption process and ensure that they meet all necessary requirements. Each document plays a role in confirming the business's compliance with New York State laws, ultimately aiding in a smoother application experience.

Similar forms

The CE-200 form is essential for entities seeking exemption from New York State Workers' Compensation and/or Disability Benefits Insurance Coverage. Several other documents serve similar purposes in various contexts. Here are seven documents that share similarities with the CE-200 form:

  • CE-200.1: Application for Certificate of Attestation of Exemption - This form is also used to apply for an exemption from workers' compensation insurance, specifically tailored for certain types of businesses and contractors.
  • DB-120: Notice of Compliance - This document certifies that a business complies with New York State Disability Benefits Law, similar to how the CE-200 certifies exemption status.
  • WC-105: Notice of Election - This form allows employers to notify the Workers' Compensation Board of their decision to opt-out of coverage, paralleling the exemption process outlined in the CE-200.
  • DB-155: Application for Disability Benefits - While this application is for claiming benefits, it also addresses the requirements for disability coverage, akin to the CE-200's focus on exemptions.
  • CE-200.2: Employer's Certificate of Exemption - This certificate is issued to businesses that qualify for exemption, functioning similarly to the CE-200 by providing official documentation of exemption status.
  • Form 1099-MISC: Miscellaneous Income - Although primarily for reporting income, it can be relevant for independent contractors who may not require workers' compensation, reflecting the same context of exemption.
  • LLC Formation Documents - These documents establish a limited liability company and often include statements about insurance requirements, similar to the CE-200's focus on business structure and employee status.

Each of these documents plays a role in navigating the complexities of workers' compensation and disability insurance in New York State, much like the CE-200 form.

Dos and Don'ts

When filling out the CE-200 form for a Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage, there are several important guidelines to follow. Here are five things you should do and five things you should avoid:

  • Do: Read the instructions thoroughly before starting the application.
  • Do: Ensure that all required fields are completed accurately.
  • Do: Use clear and legible handwriting if filling out the form by hand.
  • Do: Submit the application via fax or mail to the Workers’ Compensation Board.
  • Do: Check your information for accuracy before sending the application.
  • Don't: Leave any sections blank; incomplete applications may delay processing.
  • Don't: Use someone else's information to fill out the form.
  • Don't: Forget to sign the application; an unsigned form will not be accepted.
  • Don't: Submit the application without reviewing the separate instructions.
  • Don't: Attempt to have someone else, like an accountant or lawyer, submit the application on your behalf.

Following these guidelines can help ensure a smoother application process and reduce the likelihood of delays. Remember, attention to detail is key when dealing with official forms.

Misconceptions

Misconceptions about the CE200 form can lead to confusion regarding its use and requirements. The following list outlines ten common misconceptions along with explanations to clarify them.

  • 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 misconception. The form is also applicable for exemptions from New York State disability benefits insurance coverage.
  • Any individual can submit the CE200 form on behalf of a business. This is not true. The applicant must have the legal authority to file the application, and it cannot be submitted by an accountant or lawyer on behalf of a client.
  • The CE200 form can be submitted online for immediate processing. While there is an online application available, the standard form must be submitted by fax or mail, which may take up to four weeks to process.
  • Once submitted, the CE200 form guarantees immediate approval. This is misleading. The application will be processed in the order received, and approval is not guaranteed.
  • Homeowners cannot apply for a CE200 exemption. This is incorrect. Homeowners can apply if they are serving as general contractors for their personal residences without employing others.
  • All businesses must provide proof of insurance when applying. This is not accurate. The CE200 form is specifically for those who are exempt from needing workers’ compensation and disability benefits insurance.
  • The CE200 form is only relevant for construction businesses. This misconception overlooks that the form applies to various types of businesses, including but not limited to restaurants, farms, and nonprofits.
  • Submitting the CE200 form is a complex process. While it requires specific information, the process can be straightforward if the applicant follows the provided instructions carefully.
  • Once a CE200 certificate is issued, it is valid indefinitely. This is incorrect. The certificate is specific to the permit, license, or contract for which it was issued and may not be valid for future applications.

Key takeaways

  • 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.
  • This application is specifically for entities with no employees or for out-of-state entities whose work is performed entirely outside of New York State.
  • To complete the form, all sections must be filled out accurately, and it can be submitted via fax or mail to the Workers' Compensation Board.
  • The processing time for the application can take up to four weeks; however, an online application option is available for immediate issuance of the certificate.
  • It is essential to review the separate instructions provided with the CE-200 form before submission to ensure compliance with all requirements.
  • Applicants must sign the form, affirming that the information is true and acknowledging the penalties for providing false information.