Dwc 11 Ic Form PDF Details

In the State of Rhode Island, the designation as an independent contractor comes with particular responsibilities and implications, especially when it pertains to Workers' Compensation. The Department of Labor and Training, through its Division of Workers’ Compensation, offers a specific form for this purpose, the DWC-11-IC, which stands as a notice of Designation as Independent Contractor under the Rhode Island General Laws (RIGL) §28-29-17.1. This form is a critical document for those who operate independently, as it officially states that the signer is an independent contractor, foregoing entitlement to workers' compensation benefits typically granted to employees in the event of an injury. This declaration is essential not just for the contractors themselves but also for the hiring entities, reminding both parties of the legal distinctions and financial implications of this designation. Additionally, the form contains stern warnings against coercion, emphasizing the voluntary nature of this declaration, and it outlines the potential criminal liabilities for entities that attempt to mislead or misclassify workers. It also clarifies that this designation, while significant for workers' compensation purposes, does not automatically align with the criteria set by other regulatory bodies like the Internal Revenue Service or the RI Division of Taxation. Thus, this form serves as a pivotal point of reference for understanding the nuanced differentiation between being an employee and an independent contractor within the context of Rhode Island's labor laws.

QuestionAnswer
Form NameDwc 11 Ic Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesri dwc 11 form, dwc11 1c, dwc 11 ic ri form, dwc 11 1c

Form Preview Example

State of Rhode Island, Department of Labor and Training, Division of Workers’ Compensation

P.O. Box 20190, Cranston, RI 02920-0942

Phone (401) 462-8100 TDD (401) 462-8084 www.dlt.ri.gov

NOTICE OF DESIGNATION AS INDEPENDENT CONTRACTOR PURSUANT TO RIGL §28-29-17.1

PLEASE READ OTHER SIDE

WARNING

No one can force you to sign this form. When you sign this form you are stating that you are an independent contractor and in the event of injury, are not entitled to workers' compensation benefits.

*(Name)

*Business Name

Address

Soc. Sec. No.

FEIN

Business License No.

Date of Birth

I declare that I am an independent contractor pursuant to RIGL §28-29-17.1 and, therefore, I am not eligible for nor entitled to Workers’ Compensation benefits pursuant to Title 28, Chapters 29-38, of the Workers’ Compensation Act of the State of Rhode Island for injuries sustained while working as an independent contractor for the hiring entity named below. This designation will remain in effect while performing services for the named hiring entity or until a withdrawal of designation as independent contractor form is filed with the Department of Labor and Training.

*Hiring Entity Name

*Address

Soc. Sec. No.

FEIN

Business License No.

Warning! This form is for purposes of Workers’ Compensation only and completion of this form does not mean that you are an Independent Contractor under the rules, regulations or statutes of the Internal Revenue Service or the RI Division of Taxation. Information on this form will be shared within the Dept. of Labor and Training, the RI Division of Taxation and the Internal Revenue Service.

Independent Contractor:

Signature

Date

A hiring entity that knowingly assists, aids and abets, solicits, conspires with or coerces an employee to misrepresent the employee’s status as an independent contractor may be subject to criminal prosecution under RIGL §28-33-17.3.

*This information is available to the public including the Hiring Entity’s Workers’ Compensation Insurance Carrier.

The Department will mail a confirmation of this filing to the independent contractor within five business days. If you have any questions, call 462-8100, option 5.

DWC-11-IC (3/2006)

DWC-11-IC Reverse Side

This is a form DWC11-IC, Designation of Independent Contractor. This means that you have stated that you are an independent contractor NOT an employee and are NOT eligible for Workers’ Compensation benefits.

Many factors are considered when determining whether someone is an employee or an independent contractor. Some of those factors are: independent contractors set their own work hours, have their own tools and work when and for whom they choose.

An employer generally does not have to withhold or pay any taxes on payment to independent contractors, such as social security, Medicare, unemployment and Temporary Disability Insurance (TDI).

This form is for purposes of Workers’ Compensation, and completion of this form does not mean that you are considered an Independent Contractor under the rules, regulations or statutes of the Internal Revenue Service or the R.I. Division of Taxation.

SHOULD YOU HAVE ANY QUESTIONS ABOUT WHETHER YOU ARE AN INDEPENDENT CONTRACTOR OR AN EMPLOYEE, PLEASE CONTACT THE RI DIVISION OF TAXATION AT (401) 222-3682, OR THE US GOVERNMENT INTERNAL REVENUE SERVICE AT 800-829-1040.

IF YOU FEEL YOU HAVE BEEN COERCED OR FORCED TO SIGN THE INDEPENDENT CONTRACTOR FORM, REPORT THIS TO THE WORKERS’ COMPENSATION FRAUD AND COMPLIANCE UNIT AT (401) 462-8100, option 7.

When your work as an independent contractor ends with this employer, complete and return the form titled Notice of Withdrawal of Designation as Independent Contractor , DWC-11-ICR, to the Dept. of Labor and Training, Division of Workers’ Compensation.

If you have a question, contact the Division of Workers’ Compensation at (401) 462-8100, option 5. For further information, contact the Workers’ Compensation Information Line at (401) 462-8100, option 1.

DWC-11-IC (3/2006) Side 2

How to Edit Dwc 11 Ic Form Online for Free

Handling PDF documents online is surprisingly easy with our PDF editor. Anyone can fill out dwc 11 form ri here effortlessly. Our tool is consistently developing to grant the very best user experience attainable, and that is because of our resolve for continuous improvement and listening closely to user comments. It just takes a few basic steps:

Step 1: Press the "Get Form" button in the top area of this page to access our editor.

Step 2: As soon as you launch the tool, you will see the document all set to be completed. Besides filling out various blank fields, you could also perform other things with the Document, namely writing any textual content, modifying the initial text, inserting graphics, affixing your signature to the document, and much more.

This PDF doc requires specific details; in order to guarantee accuracy and reliability, be sure to bear in mind the subsequent tips:

1. The dwc 11 form ri will require particular details to be typed in. Ensure that the next blank fields are completed:

dwc 11 1c form conclusion process explained (stage 1)

Step 3: Check the details you've inserted in the form fields and press the "Done" button. Join FormsPal today and immediately get dwc 11 form ri, ready for downloading. Every single edit made is conveniently preserved , which enables you to edit the form at a later point as required. Here at FormsPal.com, we do our utmost to make sure that all your details are stored private.

Dwc 11 Ic Form isn’t the one you’re looking for?

Related Documents