Certificate Of Attestation Exemption Form PDF Details

The Certificate of Attestation Exemption, commonly known as the CE-200 form, is a critical compliance document for businesses operating in or near New York. The Workers' Compensation Board issues this certificate to confirm that an applicant meets the legal requirement for exemption from standard insurance coverage obligations.

Who Qualifies for the Exemption Certificate

Several types of business entities may qualify for this attestation of exemption. Sole proprietors and self-employed individuals with no employees are the most common applicants. Partnerships where each partner holds a valid exemption also qualify. Out-of-state contractors whose employees work in New York for fewer than thirty days per calendar year can apply as well. Certain nonprofit organizations and religious institutions with unique staffing arrangements may also meet the requirement for an exemption certificate.

How to Apply for the Certificate

The application process requires the applicant to provide personal information, business details, and job site location data. Each contract or permit tied to a New York project typically requires proof of coverage or an active exemption certificate. Submitting the completed form by fax or mail starts a review that can take up to four weeks. For those needing the certificate quickly, an online application allows for immediate printing of the document.

Important Compliance Requirements

All applicants must affirm the truthfulness of their responses under penalty of perjury. Providing false information carries serious legal consequences, including fines and potential loss of the license to operate. Businesses should verify that their exemption remains valid each year, as changes in employee count or medical coverage status can affect eligibility. Related forms such as the Workers' Compensation C-4 form and the TN Workers' Compensation Exemption serve different purposes but are part of the same regulatory framework.

QuestionAnswer
Form NameCertificate Of Attestation Exemption Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesCE-200 form, Certificate of Attestation of Exemption, Workers' Compensation Board exemption certificate, WCB CE-200

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