Oklahoma Form Exempt – Fill Out and Use This PDF

Check one type of filing. An Original Affidavit of Exempt Status expires at midnight two (2) years from the filing date.

A Renewal expires at midnight two (2) years from the expiration date indicated.

If renewing a current Affidavit, provide the Affidavit # and the Expiration Date.

You state under penalty of perjury, as follows. Fill in the blank after "I,".

Read, sign and attach the Exempt Status Fact Sheet. 1. Write your name as an individual, in your individual capacity or operating as your business name. Read, sign and attach the Exempt Status Fact Sheet. You have read, signed and attached it and understand the definition of "employee" and specific exceptions to that definition found in 85A O.S. §2(18). You also understand that an Independent Contractor is one who engages to perform certain services for another, according to his own manner, method, free from control and direction of his contractor in all matters connected with the performance of the service, except as to the result or product of the work. A Contractor may be either (i) the owner of a project or job or (ii) an Independent Contractor in any tier who has subcontracted with a subcontractor. 2. You understand that based upon the representations in this Affidavit of Exempt Status ("Affidavit"), you are requesting that the recipient of this Affidavit consider your business to either (i) be exempt from the definition of "employee" or (ii) be that of an independent contractor, and that no workers' compensation insurance premium be charged for the services performed by your business. You do not want workers' compensation insurance and understand that you are not eligible for workers' compensation benefits. 3. In the event changed circumstances make securing compensation pursuant to the requirements of the Administrative Workers' Compensation Act necessary, you will execute and file a Cancellation of Affidavit of Exempt Status with the Workers' Compensation Commission. You will obtain workers' compensation and employers' liability insurance for your employees if you have employees, unless they are otherwise exempt from the requirements of the Administrative Workers' Compensation Act. 4. The information you have provided is not the result of force, threats, coercion, compulsion or duress. 5. You understand that the execution of this Affidavit, if you are an independent contractor, shall establish a conclusive presumption that you are not an employee for purposes of the Administrative Workers' Compensation Act. 6. You understand that the execution of this Affidavit shall not affect the rights or coverage of any employee of the individual or business executing this Affidavit. 7. You understand if any contractor or its insurer shall become liable under the Administrative Workers' Compensation Act for the payment of compensation due to a compensable work related injury of your employee(s), the contractor or its insurer may recover from you the amount of such compensation paid or for which liability is incurred. 8. You understand that knowingly providing false information on an executed Affidavit of Exempt Status shall constitute a misdemeanor punishable by a fine not to exceed One Thousand Dollars ($1,000.00). (checked October 31, 2026)

You declare under PENALTY OF PERJURY that you have examined all statements contained herein, and to the best of your knowledge and belief, they are true, correct and complete.

Write the Affiant Name, Title and Phone.

Write the Business Name and Email.

Write the FEIN/EIN/TIN # and Mailing Address.

Sign on the Affiant Signature line and write the Date.

File original and one (1) copy with the Workers' Compensation Commission (WCC) in-person or by mail, or file online at www.ok.gov/wcc. CHECKS WILL NOT BE ACCEPTED. Must be accompanied by a nonrefundable $50 filing fee payable to the WCC. (checked October 31, 2026)

Statements to help you decide if you are an independent contractor.

The AWCA does not define "independent contractor."

Oklahoma law considers an independent contractor to be one who engages to perform certain services for another, according to his or her own manner and method, free from control and direction of his or her contractor in all matters connected with the performance of the service, except as to the result or product of the work.

Independent Contractors are not "employees" for purposes of the AWCA.

No one statement is controlling, and your status is based on all the facts in your situation.

The nature of the contract between you and the contractor.

The contractor exercises very litle control over your work.

You are engaged in a disƟnct occupaƟon or business for others.

Your job is the kind of occupaƟon where the work is usually performed by a specialist without supervision, and not under the direcƟon of the contractor.

Your occupaƟon requires special skills, license, educaƟon or training.

The contractor does not supply the things needed to perform your job such as the tools and the place of work.

The length and duraƟon of the job does not show that you are really an employee.

You are paid as a separate contractor, not as an employee.

Your work is not the regular business of the employer.

You do not consider yourself an employee of the contractor.

You do not have the right to terminate the relaƟonship without liability.