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Form Dwc 83 PDF Details

Form Dwc 83 is an important document that should be filed when starting a new business. The form can be used to register a trade name, request tax ID numbers, and more. By completing the form and submitting it to the correct agency, businesses can ensure that their legal requirements are met. In this blog post, we will provide an overview of Form Dwc 83 and explain why it is important for businesses to complete and submit the form. We will also provide tips on how to fill out the form correctly. Finally, we will list some of the agencies that accept Form Dwc 83 submissions.

You might find it beneficial to understand how much time you will need to prepare this form dwc 83 and how long the form is.

Question	Answer
Form Name	Form Dwc 83
Form Length	1 pages
Fillable?	Yes
Fillable fields	24
Avg. time to fill out	5 min 7 sec
Other names	dwc83 form, dwc form 83, dwc form 83 texas, dwc83

12

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TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION

7551 Metro Center Drive, Suite 100

Austin, Texas 78744

If you are not certain whether all parties meet the requirements for entering into this agreement, you may wish to consult an attorney.

Texas Workers' Compensation Act, Texas Labor Code, Section 406.141(2) defines "independent contractor" as follows: (2) "Independent contractor" means a person who contracts to perform work or

provide a service for the benefit of another and who: (A) is paid by the job, not by the hour or some other time-measured basis; (B) is free to hire as many helpers as he desires and to determine what each helper will be paid; and (C) is free to work for other contractors, or to send helpers to work for other contractors, while under contract to the hiring employer.

CHECK BOX OF STATEMENT THAT APPLIES

JOINT AGREEMENT TO AFFIRM INDEPENDENT

RELATIONSHIP FOR CERTAIN BUILDING

AND CONSTRUCTION WORKERS

Notice of Declaration

The undersigned Hiring Contractor and the undersigned Independent Contractor hereby declare that the Independent Contractor meets the qualifications of an Independent Contractor under Texas Workers' Compensation Act, Texas Labor Code, Section 406.141, that the Independent Contractor is not an employee of the Hiring Contractor, and that:

(A)the Independent Contractor and the Independent Contractor's employees shall not be entitled to workers' compensation coverage from the Hiring Contractor; and

(B)the Hiring Contractor's workers' compensation insurance carrier shall not require premiums to be paid by the Hiring Contractor for coverage of the Independent Contractor or the Independent Contractor's employees,

helpers, or subcontractors.

__________________________________________________________________

THIS DECLARATION TAKES EFFECT UPON RECEIPT BY THE TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION. THIS DECLARATION APPLIES TO ALL HIRING AGREEMENTS EXECUTED BY THE HIRING CONTRACTOR AND THE INDEPENDENT CONTRACTOR DURING THE YEAR AFTER THIS DECLARATION IS FILED UNLESS A SUBSEQUENT HIRING AGREEMENT IS MADE TO WHICH THE DECLARATION DOES NOT APPLY. IN THE EVENT THAT A HIRING AGREEMENT TO WHICH THIS DECLARATION DOES NOT APPLY IS MADE, THE HIRING CONTRACTOR AND INDEPENDENT CONTRACTOR SHALL SO NOTIFY THE TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION AND THE HIRING CONTRACTOR'S WORKERS' COMPENSATION INSURANCE CARRIER (IF ANY) IN WRITING WITHIN 10 DAYS AFTER THE NON-APPLYING AGREEMENT IS MADE. ONCE THIS AGREEMENT IS SIGNED, THE SUBCONTRACTOR AND THE SUBCONTRACTOR'S EMPLOYEES SHALL NOT BE ENTITLED TO WORKERS' COMPENSATION COVERAGE FROM THE HIRING CONTRACTOR UNLESS A SUBSEQUENT WRITTEN AGREEMENT IS EXECUTED, AND FILED ACCORDING TO WORKERS’ COMPENSATION RULES, EXPRESSLY STATING THAT THIS AGREEMENT DOES NOT APPLY.

AGREEMENT TO ESTABLISH EMPLOYER- EMPLOYEE RELATIONSHIP FOR CERTAIN BUILDING AND CONSTRUCTION WORKERS

Notice of Agreement

The undersigned Hiring Contractor and the undersigned Independent Contractor hereby agree

that the Hiring Contractor will withhold will not withhold the cost of workers' compensation insurance coverage from the Independent Contractor's contract price and that the Hiring Contractor will purchase workers' compensation insurance coverage for the Independent Contractor and the Independent Contractor's employees. Once this agreement is signed, for the purpose of providing workers' compensation insurance coverage, the Hiring Contractor will be the employer of the Independent Contractor and the Independent Contractor's employees. This agreement makes the Hiring Contractor the employer of the Independent Contractor and the Independent Contractor's employees only for the purposes of workers' compensation laws of Texas and for no other purpose.

TERM (DATES) OF AGREEMENT:	FROM: _____________________
	TO: ________________________

LOCATION OF EACH AFFECTED JOB SITE (OR STATE WHETHER THIS IS A BLANKET AGREEMENT):

_________________________________________________________________

__________________________________________________________________

___________________________________________________________________

ESTIMATED NUMBER OF EMPLOYEES AFFECTED: _________________

THIS AGREEMENT SHALL TAKE EFFECT NO SOONER THAN THE DATE IT IS SIGNED.

Hiring Contractor's Affirmation

If the Hiring Contractor's workers' compensation carrier change
during the effective period of coverage, it is advisable for the Hiring Contractor		__________________________________
to file this form with the new insurance carrier.		Federal Tax I.D. Number
______________________________________________	______________________	________________________________________________________________
Signature of Hiring Contractor	Date	Address (Street)
________________________________________________________________________		________________________________________________________________
Printed Name of the Hiring Contractor		Address (City, State, Zip)

	Independent Contractor's Affirmation		____________________________
			Federal Tax I.D. Number
______________________________________________	______________________	________________________________________________________________
Signature of Independent Contractor	Date	Address (Street)
________________________________________________________________________		________________________________________________________________
Printed Name of the Independent Contractor		Address (City, State, Zip)

Four copies of this form must be completed: This agreement must be filed by the Hiring Contractor with both the Texas Department of Insurance, Division of Workers’ Compensation and the workers’ compensation insurance carrier of the Hiring Contractor within 10 days of the date of execution. The original must be filed with the Division. The agreement must be filed by PERSONAL DELIVERY OR REGISTERED OR CERTIFIED MAIL. Both the Hiring Contractor and the Independent Contractor must also retain a copy of the agreement.

Division Date Stamp Here

DWC FORM-83 (Rev. 10/05)

DIVISION OF WORKERS’ COMPENSATION

How to Edit Form Dwc 83 Online for Free

This PDF editor was designed to be as simple as possible. While you adhere to the next steps, the procedure for completing the dwc 83 form document will be trouble-free.

Step 1: You can click the orange "Get Form Now" button at the top of the following website page.

Step 2: Once you've accessed the dwc 83 form editing page you can discover all the functions you'll be able to conduct with regards to your document at the top menu.

Fill out the dw, c 83 form PDF by typing in the data meant for each individual part.

entering details in dwc83 part 1

Write down the information in Date, Hiring, Contractors, Affirmation Federal, TaxI, D, Number Address, Street Address, City, State, Zip Independent, Contractors, Affirmation Federal, TaxI, D, Number Date, Address, Street Address, City, State, Zip and Division, Date, Stamp, Here

dwc83 Date, HiringContractorsAffirmation, FederalTaxIDNumber, AddressStreet, AddressCityStateZip, IndependentContractorsAffirmation, FederalTaxIDNumber, Date, AddressStreet, AddressCityStateZip, and DivisionDateStampHere blanks to fill out

Step 3: If you're done, hit the "Done" button to transfer the PDF document.

Step 4: In order to avoid any sort of difficulties in the future, you should create as a minimum a couple of duplicates of your file.

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