Form DWC083 at a glance
What it is: Form DWC083 is a joint agreement to affirm independent relationship, or an agreement to establish employer-employee relationship, for certain building and construction workers.
Who signs: The hiring contractor signs in 13. Signature of hiring contractor and enters in 14. Date of signature (mm/dd/yyyy) the date. The independent contractor signs in 20. Signature of independent contractor and enters in 21. Date of signature (mm/dd/yyyy) the date.
Where to get it: Find forms at www.tdi.texas.gov/forms/form20numeric.html.
A filled-in Form DWC083 example: a hiring contractor starts a job-site agreement
How to fill out Form DWC083, box by box
Part 1. Agreements, check only one
In Part 1. Agreements, check only one: Joint agreement to affirm independent relationship for certain building and construction workers, or Agreement to establish employer-employee relationship for certain building and construction workers. Complete items 1-7 as appropriate. In 1. Type of agreement, mark Blanket agreement or Job-site specific agreement.
Dates and estimated number of employees affected
In 2. Agreement start date (mm/dd/yyyy), enter the start date.
In 3. Agreement end date (mm/dd/yyyy), enter the end date.
In 4. Estimated number of employees affected, enter the number.
Location of job sites covered under agreement
Under Location of job sites covered under agreement, enter an address (street or PO box, city, state, ZIP code) in 5. Address, 6. Address and 7. Address.
Attach a sheet with additional locations if needed. Part 2. The hiring contractor must complete this part.
Part 2. The hiring contractor, boxes 8 to 11
Enter the hiring contractor name in 8. Hiring contractor name, the Federal tax ID number in 9. Federal tax ID number, the address (street or PO box, city, state, ZIP code) in 10. Address and the email in 11. Email.
12. Hiring contractor's affirmations: Joint agreement
12. Hiring contractor's affirmations Check only one: Joint agreement to affirm independent relationship for certain building and construction workers. The hiring contractor declares that the independent contractor meets the qualifications under Texas Labor Code Section 406.141, and the independent contractor is not an employee of the hiring contractor. The independent contractor and the independent contractor's employees are not entitled to workers' compensation insurance coverage from the hiring contractor. The hiring contractor's workers' compensation insurance carrier will not require the hiring contractor to pay premiums to cover the independent contractor or the independent contractor's employees, helpers, or subcontractors. Once this agreement is signed, the subcontractor and the subcontractor's employees will not be entitled to workers' compensation coverage from the hiring contractor unless a subsequent written agreement is signed, and filed according to division rules, expressly stating that this agreement does not apply.
Agreement to establish employer-employee relationship, withhold or not withhold
Agreement to establish employer-employee relationship for certain building and construction workers: the hiring contractor will withhold or not withhold the cost of workers' compensation insurance coverage from the independent contractor's price. The hiring contractor will purchase workers' compensation insurance coverage for the independent contractor and the independent contractor's employees. The hiring contractor agrees that the hiring contractor is the employer of the independent contractor for the purpose of providing workers' compensation insurance coverage, and no other purpose.
13 and 14. Signature of hiring contractor
The hiring contractor signs in 13. Signature of hiring contractor and enters in 14. Date of signature (mm/dd/yyyy) the date.
Part 3. The independent contractor, boxes 15 to 18
Part 3. The independent contractor must complete this part.
Enter the independent contractor name in 15. Independent contractor name, the Federal tax ID number in 16. Federal tax ID number, the address (street or PO box, city, state, ZIP code) in 17. Address and the email in 18. Email.
19. Independent contractor's affirmations: Joint agreement
19. Independent contractor's affirmations Check only one: Joint agreement to affirm independent relationship for certain building and construction workers. The independent contractor declares that the independent contractor meets the qualifications under Texas Labor Code Section 406.141 and is not an employee of the hiring contractor.
Agreement to establish employer-employee relationship, the hiring contractor employs the independent contractor
Agreement to establish employer-employee relationship for certain building and construction workers: the independent contractor agrees that the hiring contractor employs the independent contractor for the purpose of providing workers' compensation insurance coverage, and no other purpose.
20 and 21. Signature of independent contractor
The independent contractor signs in 20. Signature of independent contractor and enters in 21. Date of signature (mm/dd/yyyy) the date.
More rules for Form DWC083
The agreement takes effect the date both parties have signed it or on the start date of the agreement, whichever is later.
How do I know if I should sign this agreement? You may want to talk to an attorney if you are not sure if all parties meet the requirements to enter into these agreements.
The hiring contractor must keep the original.
The independent contractor should also keep a copy.
If the hiring contractor changes workers' compensation insurance carriers during the effective dates of the agreement, the hiring contractor should file this form with their new insurance carrier.
Independent contractor, subcontractor and a new hiring agreement
Agree that the independent contractor is not an employee of the hiring contractor
Who may use this agreement? Texas Labor Code Section 406.145 allows certain building and construction workers, specifically, hiring contractors and independent contractors, to agree that the independent contractor is not an employee of the hiring contractor, and the hiring contractor is not responsible for workers' compensation insurance coverage for the independent contractor.
Who is an independent contractor? Texas Labor Code Section 406.141(2) defines an independent contractor as a person who contracts to perform work or provide a service for the benefit of another, and who is paid by the job, not by the hour or some other time-measured basis; free to hire as many helpers as desired and determine what to pay each helper; and free to work for other contractors or send helpers to work for other contractors, while under contract with the hiring employer.
How long is the joint agreement to affirm an independent relationship in effect? Texas Labor Code Section 406.145 states that the agreement to affirm an independent relationship applies to all hiring agreements the hiring contractor and the independent contractor make until the first anniversary of the date the hiring contractor filed the agreement with their workers' compensation insurance carrier.
Agree on who will provide workers' compensation insurance coverage to the subcontractor
Texas Labor Code Section 406.144 allows certain building and construction workers, specifically, hiring contractors and independent contractors, to agree on who will provide workers' compensation insurance coverage to the subcontractor and the employees of the subcontractor.
A new hiring agreement states that this agreement does not apply
The agreement does not apply to a new hiring agreement if the new agreement states this agreement does not apply.
The hiring contractor and independent contractor must notify the hiring contractor's workers' compensation insurance carrier in writing within 10 days after the date they make a hiring agreement that does not apply to this agreement.
The hiring contractor and independent contractor must make a new written agreement to establish an employer-employee relationship and provide workers' compensation insurance coverage. The new written agreement must state that this agreement does not apply.
The hiring contractor and independent contractor can use DWC Form-084, Exception to Application of a Joint Agreement to Affirm Independent Relationship for Certain building and Construction Workers.
Common questions about Form DWC083
Where do I file it?
The hiring contractor must file a legible and complete copy of this agreement with their workers' compensation insurance carrier within 10 days after signing the agreement. Where should I send this agreement? You may file this form with Texas Department of Insurance, Division of Workers' Compensation (DWC) under Labor Code Section 406.145.
Sources
[1] Form DWC083 (Rev. 10/21), Texas Department of Insurance, Division of Workers' Compensation (the Official source link on this page).
