Form C 1Am PDF Details

In the event that you are injured and unable to work, there is a form you will need to fill out in order to receive benefits from your employer. This form is called Form C-1am, and it is used to apply for workers' compensation benefits. In this blog post, we will discuss what Form C-1am is, who needs to fill it out, and what happens after it has been submitted. We will also provide a link to a free online resource where you can download the form yourself.

QuestionAnswer
Form NameForm C 1Am
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesc1am twc tax area form

Form Preview Example

Mail To:

Cashier - Texas Workforce Commission P.O. Box 149037

Austin, TX 78714-9037 512.463.2731 www.texasworkforce.org

Amended Status Report

This report should be used to update your account with TWC Please complete Items 1 through 8, any other item that needs to be updated, and sign the report in Item 20 on the back.

TWC Use Only

County Code

Tax Area

 

 

 

 

Identification Section

 

1. Account Number assigned by TWC

 

 

5. Federal Employer ID Number

 

 

 

 

 

 

 

2. Name

6. Area Code/Phone Number

3. Mailing address

7. Address of Records/Payroll

4. City, State, Zip

8. City, State, Zip

9. Owners’ or Officers’ Name

Soc. Sec. No.

Title

Residence Address, City, State

10. Business location(s) in Texas

Trade Name

Street Address, City

Kind of Business

No. Employees

 

 

 

 

 

 

 

 

 

 

 

 

Acquisition Section

11. If you acquired the business in Texas from a previous owner, you must complete Items 11-14.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mo.

Day

 

Yr.

 

 

 

 

 

 

 

 

 

 

 

Acquisition Date :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous Owner’s TWC Account Number (if known):

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous Owner’s Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous Owner’s Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

 

Portion of business acquired:

All

 

 

 

 

 

 

 

 

 

 

 

 

 

(check one):

Part (specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. On the date of the acquisition, was the previous owner(s), or any partner(s), officer(s), shareholder(s), other owner(s) or a person

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

related by blood or marriage to any of these individuals, holding a legal or equitable interest in the predecessor business, also an owner,

 

 

 

 

 

 

partner, officer, shareholder, or other owner of a legal or equitable interest in the successor business?

 

 

 

 

 

 

 

 

If “yes”, check all that apply:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If other, describe:

 

 

 

 

 

 

 

 

 

 

Same owner, officer, partner, or shareholder

 

 

Same parent company

 

 

 

 

 

 

 

 

 

 

 

Sole proprietor incorporating

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

If “No”, on the date of the acquisition, did the previous owner(s), partner(s), officer(s), shareholder(s), other

 

Yes

No

 

 

 

 

owner(s) or a person related by blood or marriage to any of these individuals, holding a legal or equitable interest in the

 

 

 

 

 

 

 

 

predecessor business, hold an option to purchase such an interest in the successor business?

 

 

 

 

 

 

 

 

14. After the acquisition, did the predecessor continue to:

 

 

 

 

 

 

Yes

No

 

 

 

 

•

Own or manage the organization that conducts the organization, trade or business?

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

•

Own or manage the assets necessary to conduct the organization, trade or business?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

•

Control through security or lease arrangement, the assets necessary to conduct the organization, trade or business?

 

Yes

No

 

 

 

 

•

Direct the internal affairs or conduct of the organization, trade or business?

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes to any of above, describe:

Page 1 of 2

C-1AM (050907)

Reopen Section

15. If you are filing this report to reactivate your inactive account, complete this section.

Mo.

Day

Yr.

The date you resumed employing individuals in Texas:

The date you resumed paying wages in Texas:

Suspend Section

16. If you are filing this report to inactivate your account, complete this section.

Mo.

Day

Yr.

The last day on which individuals performed services in Texas:

The date on which final wages were paid:

Employment in Texas was discontinued because:

(Check one):

Business discontinued entirely without a successor.

Business continued without employment.

Business, trade or organization was acquired by a successor.

If you sold a business in Texas you must complete Items 16 through 19.

Successor’s TWC Account Number (if known):

 

Successor’s Name:

 

 

Successor’s Address:

 

 

City, State, Zip:

 

Successor Acquired:

All the Texas business or assets.

(Check one):

Part of the Texas business or assets. Part Acquired (specify):

 

17.On the date of the acquisition, was the previous owner(s), or any partner(s), officer(s), shareholder(s), other owner(s) or a person related by blood or marriage to any of these individuals, holding a legal or equitable interest in the predecessor business, also an owner, partner, officer, shareholder, or other owner of a legal or equitable interest in the successor business?

YES

NO

If “Yes”, check all that apply:

Same owner, officer, partner or shareholder Same parent company

Sole proprietor incorporating Other (Described below)

18. If “No”, on the date of the acquisition, did the previous owner(s), partner(s), officer(s), shareholder(s), other owner(s) or a person

 

 

related by blood or marriage to any of these individuals, holding a legal or equitable interest in the predecessor business, hold an option

YES

NO

to purchase such an interest in the successor business?

 

 

19. After the acquisition, did the predecessor continue to:

 

 

• Own or manage the organization that conducts the organization, trade of business?

YES

NO

• Own or manage the assets necessary to conduct the organization, trade or business?

YES

NO

• Control through security or lease arrangement the assets necessary to conduct the organization, trade or business?

YES

NO

• Direct the internal affairs or conduct of the organization, trade or business?

YES

NO

 

 

 

If “Yes” to any of above, describe:

Signature Section

20.I hereby certify that the preceding information is true and correct, and that I am authorized to execute this Amended Status Report on behalf of the Employing Unit named herein. (This report must be signed by the owner, officer, partner OR individual with a valid Written Authorization on file with the Texas Workforce Commission.)

Date Signed

Mo.

Day

Yr.

Signature

Title

E-mail Address

Individuals may receive, review, and correct information that TWC collects about the individual by emailing to open.records@twc.state.tx.us or writing to TWC Open Records, 101 East 15th St., Rm. 266, Austin, TX 78778-0001.

Page 2 of 2

C-1AM (050907)

How to Edit Form C 1Am Online for Free

Working with PDF files online is actually a piece of cake with our PDF editor. Anyone can fill out Form C 1Am here painlessly. In order to make our editor better and less complicated to use, we constantly design new features, considering suggestions from our users. If you're looking to begin, here's what you will need to do:

Step 1: Click the "Get Form" button in the top part of this webpage to access our tool.

Step 2: Using this state-of-the-art PDF file editor, you're able to accomplish more than merely complete blank form fields. Edit away and make your forms look great with custom text put in, or modify the file's original input to excellence - all that supported by an ability to incorporate your own photos and sign the document off.

So as to fill out this form, ensure that you enter the right details in each and every blank:

1. Whenever filling in the Form C 1Am, make certain to complete all of the needed fields within its corresponding part. It will help facilitate the work, making it possible for your information to be processed efficiently and correctly.

Form C 1Am completion process explained (step 1)

2. Soon after filling in the previous step, go to the subsequent stage and fill out the necessary particulars in all these blank fields - Previous Owners TWC Account Number, Previous Owners Name, Previous Owners Address, Acquisition Date, Portion of business acquired, check one, City State Zip, All Part specify, On the date of the acquisition, Yes, If yes check all that apply, Same owner officer partner or, Same parent company, If other describe, and If No on the date of the.

On the date of the acquisition, check one, and Yes in Form C 1Am

3. Completing If you are filing this report to, The date you resumed employing, The date you resumed paying wages, Suspend Section, The last day on which individuals, The date on which final wages were, Day, Day, Employment in Texas was, Check one, Business discontinued entirely, Business continued without, Business trade or organization was, If you sold a business in Texas, and Successors TWC Account Number if is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Part # 3 in submitting Form C 1Am

Those who use this form generally make some mistakes while filling in Employment in Texas was in this part. You need to re-examine whatever you type in here.

4. The fourth paragraph comes with all of the following blanks to consider: On the date of the acquisition, If Yes check all that apply, Same owner officer partner or, Sole proprietor incorporating, If No on the date of the, After the acquisition did the, If Yes to any of above describe, Signature Section, YES, YES, YES YES YES YES, NO NO NO NO, I hereby certify that the, named herein This report must be, and Commission.

Form C 1Am conclusion process outlined (stage 4)

5. To conclude your document, the last segment incorporates several additional blanks. Completing CAM, Email Address, Individuals may receive review and, about the individual by emailing, TWC Open Records East th St Rm, and Page of will certainly wrap up the process and you'll definitely be done in no time at all!

Part # 5 of filling in Form C 1Am

Step 3: Glance through everything you have typed into the blank fields and then press the "Done" button. Make a free trial subscription with us and obtain direct access to Form C 1Am - with all changes preserved and accessible in your FormsPal cabinet. We don't sell or share the information you provide when dealing with forms at our website.

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