This form is for workers' compensation purposes only and does not mean that you are considered an Independent Contractor according to the Internal Revenue Service or the RI Division of Taxation.
In effect: this designation will remain in effect for one year or until a withdrawal of designation as independent contractor form is filed.
Questions: the independent contractor must answer 4 questions: do you have employees, sub-contractors, General Liability Insurance, Workers' Compensation Insurance?
Confirmation: confirmation of filings is mailed to both the independent contractor and the hiring entity.
| Question | Answer |
|---|---|
| Form Name | DWC 11 IC |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 21 |
| Avg. time to fill out | 4 min |
| Edition | Rev 01/24 |
| Issuing agency | Rhode Island Department of Labor and Training, Division of Workers' Compensation |
| In effect | One year or until a withdrawal of designation as independent contractor form is filed |
| Other names | DWC 11 IC, DWC-11-IC, DWC-11, DWC11, Notice of Designation as Independent Contractor, RI independent contractor form |
| Official source | DWC 11 IC (Rev 01/24), Rhode Island Department of Labor and Training, Division of Workers' Compensation |
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