State Of New Mexico Form Wc 1 ≡ Fill Out Printable PDF Forms Online

State Of New Mexico Form Wc 1 PDF Details

The State of New Mexico Form WC 1 is a workers' compensation form used to report an injury or illness. The form must be completed within seven days of the incident, and should include information about the injury or illness, as well as the employee's name and contact information. The State of New Mexico Department of Workforce Solutions provides detailed instructions on how to complete the form. Failure to report an injury or illness in a timely manner may result in penalties. For more information, visit the State of New Mexico Department of Workforce Solutions website.

You can find info about the type of form you need to prepare in the table. It can show you how much time it takes to fill out state of new mexico form wc 1, what fields you will need to fill in, and so on.

Question	Answer
Form Name	State Of New Mexico Form Wc 1
Form Length	1 pages
Fillable?	Yes
Fillable fields	28
Avg. time to fill out	5 min 55 sec
Other names	New_Mexico, XXXXXXXXXXXXXXXXXXXXXXXXXXXXX, nm wc 1, FEIN

12

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RPD-41054 Rev. 08/2010

STATE OF NEW MEXICO

TAXATION AND REVENUE DEPARTMENT

WC-1 - WORKERS' COMPENSATION FEE FORM

Beginning with calendar quarter ending September 30, 2004, the quarterly workers' compensation fee paid on Form WC-1 increased from $4 to $4.30 per covered worker (employee). Only the employer's share increased.

See the instructions for details.

WHO MUST FILE: Every employer who is covered by the Workers' Compensation Act, whether by requirement or election, must file and pay the New Mexico Workers' Compensation Fee and file Form WC-1. See the instructions for requirements.

*IMPORTANT: On Line 1, enter the number of workers (employees) to whom the Workers' Compensation Fee applies. This is the number of covered employees you employed on the last working day of the calendar quarter. If you have no covered employees, enter zero.

WHEN TO FILE: The Workers' Compensation Fee is due on or before the last day of the month following the close of the report period. A report period is a calendar quarter ending March 31, June 30, September 30 and December 31.

Upon completion of this form, sign, date and enter your phone number and E-mail address on the form. Make the check or money order payable to Taxation and Revenue Department.

Mail the bottom portion of this form with payment to New Mexico Taxation and Revenue Department, P.O. Box 2527, Santa

Fe, NM 87504-2527. Retain the top portion for your records. For assistance call (505) 827-0832.

A.FEIN:

B.CRS:

C.EAN:

NAME:

STREET/BOX:

CITY, STATE, ZIP:

REPORT PERIOD:

Beginning (mm-dd-yy) Ending (mm-dd-yy)

1. *Number of covered
1. *Number of covered
	workers at close of
	report period	1.
2.	Assessment fee	2.	$
3.	Penalty	3.	$
4.	Interest	4.	$
5.	Total due	5.	$

PLEASE CUT AND INCLUDE THE BOTTOM PORTION WITH YOUR PAYMENT

RETAIN THE UPPER PORTION FOR YOUR RECORDS

WORKERS' COMPENSATION FEE (WC-1)

A.	FEIN:

B.	CRS:

REPORT PERIOD:

Beginning (mm-dd-yy)

Ending (mm-dd-yy)

C. EAN:

NAME:

STREET/BOX:

CITY, STATE, ZIP:

1.*Number of covered workers at close of report period

2.Assessment fee

3.Penalty

4.Interest

5.Total due

1.

2.$

3.$

4.$

5.$

Check if amended

Signature ___________________________________ Phone ______________ Date _____________ E-mail address __________________________

Mail to: Taxation and Revenue Department, P.O. Box 2527, Santa Fe, NM 87504-2527

WKC

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nm wc 1 empty spaces to complete

In the A, FEIN B, CRS CE, AN, NAME STREET, BOX CITY, STATE, ZIP REPORT, PERIOD Beginning, mm, dd, yy Ending, mm, dd, yy Assessment, fee, Penalty Interest, Total, due Signature, Phone, Date, Email, address, W, KC and Check, if, amended field, note your data.

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