The Texas Form Notice is a document that informs the tenant of their lease termination. The notice must be written in accordance with the Texas Property Code Sections 91.001-91.005, and state the specific reason for the termination. In order to terminate a lease agreement, the landlord must provide written notice to the tenant no less than 30 days before the intended move-out date, which specified in the notice. If you are a landlord in Texas, it is important to familiarize yourself with these statutes to ensure you are following all required procedures when terminating a tenancy agreement. For more information on this and other topics related to landlords and tenants in Texas, contact an attorney with experience in this area of law.
You will see details about the type of form you need to complete in the table. It will show you the amount of time you will need to finish texas form notice, what fields you need to fill in and some further specific details.
Question | Answer |
---|---|
Form Name | Texas Form Notice |
Form Length | 3 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 45 sec |
Other names | form dwc005, texas department of insurance form dwc005, texas department of insurance dwc form 005, insurance notice no |
Texas Department of Insurance |
DWC005 |
Division of Workers' Compensation - Insurance Coverage |
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7551 Metro Center Drive, Suite 100, Austin, Texas |
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(800) |
Submit Form |
Employer Notice of No Coverage or Termination of Coverage
La versión en español está disponible en http://www.tdi.texas.gov/forms/dwc/dwc005snocov.pdf
I. EFFECTIVE DATES (The effective dates cannot exceed a
The election selected below is effective from
(mm/dd/yyyy) to
(mm/dd/yyyy).
II. STATEMENT OF NO COVERAGE
1. SELECT ONE
The employer named below DOES NOT HAVE workers' compensation insurance coverage, pursuant to the Texas Workers' Compensation Act, Texas Labor Code, Section 406.004.
OR
The employer named below HAS TERMINATED workers' compensation insurance coverage, pursuant to the Texas Workers' Compensation Act, Texas Labor Code, Section 406.007. (Provide the following information.)
Policy terminated effective (mm/dd/yyyy):
Policy number:
Insurance company:
Insurer informed of termination on (mm/dd/yyyy):
Employees were (or will be) notified on (mm/dd/yyyy):
III. STATEMENT OF REPORTABLE INJURIES OR DISEASES
2.Did you have any death, injury that resulted in the injured employee's absence from work for more than one day, or knowledge of an occupational disease since your last Employer Notice of No Coverage or Termination of Coverage?
Yes No
If your response is “Yes”, you may be required to file a DWC
IV. PRIMARY EMPLOYER INFORMATION
3. Employer Business Name |
4. Federal Employer ID Number |
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5. Employer Business Mailing Address (Street or PO Box, City State Zip) |
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6. Employer Business Type |
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NOTE: You must provide name, Federal Employer ID number and address of each Texas business location, subsidiary, or separate entity of the primary employer covered by this report.
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V. PERSON PROVIDING INFORMATION |
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8. Name |
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9. Telephone Number (area code, number, extension) |
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10. Title |
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12. Signature |
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13. Date of Signature (mm/dd/yyyy) |
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DWC005 Rev. 02/18 |
Page 1 of 3 |
DWC005
Frequently Asked Questions
Employer Notice of No Coverage or Termination of Coverage
Who must file the DWC
You must file the DWC
∙do not have workers' compensation insurance, or
∙you have terminated your workers' compensation insurance coverage
However, if your only employees are exempt from coverage under the Texas Workers' Compensation Act (for example, certain domestic workers, and certain farm and ranch workers) you do not have to file.
Failure to file the form when required may subject the employer to administrative penalties.
How do I file the DWC
Employers can submit the DWC
∙filing electronically on the TDI website at: https://txcomp.tdi.state.tx.us/TXCOMPWeb/common/home.jsp:
∙faxing the form to (512)
∙mailing the form to the address listed at the top of the form.
When do I file the DWC
You must file a separate DWC
∙Annually between February 1st and April 30th of each calendar year;
∙Within 30 Days of hiring your first employee, unless this due date falls between February 1st and April 30th and you submit the form within this time period;
∙Within 10 Days of receiving a request (to file the DWC
∙Within 10 Days after notifying your workers' compensation insurance carrier that you are terminating coverage unless you purchasea new policy or become a certified
How do I determine my filing start date?
Use May 1, unless:
1.You have never filed a DWC
2.You terminated workers' compensation insurance coverage, then the start date is the first date you did not have coverage.
3.You hired your first employee, then the start date is the first day the employee started working.
How do I determine my filing period end date?
Use April 30, unless:
∙You purchased, or plan to purchase a workers' compensation insurance policy, then the End Date is the last date you did not, or will not, have coverage.
What is a NAICS code?
NAICS (pronounced "nakes") is the
1.Block 5 of your Unemployment Quarterly Report (Form
2.If you have multiple NAICS codes, they may appear in the left margin of the Multiple Worksite Report - BLS 3020 from the U.S. Bureau of Labor Statistics; or
3.For more help with NAICS codes, visit the NAICS web page at:
www.naics.com
Select "Find Your NAICS Code" from the top menu and use the "NAICS Keyword Search" to enter one or more words that generally describe your business. For example, if you are in the restaurant business, enter "restaurant" and get a complete listing of NAICS codes for the restaurant industry.
DWC005 Rev. 02/18 |
Page 2 of 3 |
Are any fields on the DWC |
DWC005 |
All applicable fields must be completed each time the DWC
Section I
∙The effective dates are always required.
Section II
∙When reporting cancellation or termination of workers' compensation insurance in Statement of No Coverage, the policy and insurer information, and the notification dates must be provided.
Section III
∙A selection from Statement of Reportable Injuries or Diseases is always required.
Section IV
∙All primary employer fields (boxes 3 through 7) are required.
∙Additional business location information is required when applicable.
Section V
∙The signature field is not required when filing online.
How/when must a
You must post the Notice to Employees Concerning Workers' Compensation in Texas in the workplace in English, Spanish and any other language common to the employer's employee population in the print type specified by DWC rules whenever you:
1.elect to not have workers' compensation insurance;
2.cancel or terminate workers' compensation insurance;
3.withdraw from certified
4.have workers' compensation coverage cancelled by the insurance company.
You must also provide this notice to each employee:
1.at the time of hire;
2.when the employer elects to not have workers' compensation insurance;
3.within 15 days of notification to the insurance carrier that the employer is terminating coverage unless the employermaintains continuous coverage under a new policy or becomes a certified
4.within 15 days of cancellation by the insurance company.
The required notice may be found on the TDI website at:
http://www.tdi.texas.gov/forms/dwc/notice5.pdf (English) and
http://www.tdi.texas.gov/forms/dwc/notice5s.pdf (Spanish)
Are
You must report
1.You have five or more employees and do not have workers' compensation insurance; or
2.you have employee(s) that have waived workers' compensation insurance coverage, whether or not you have workers' compensation insurance.
You must file the form not later than the 7th day of the month following any month in which:
∙a
∙an employee was absent from work for more than one day* as a result of a
∙you acquired knowledge of an occupational disease.
*Do not count the day of the injury or the day the injured employee returned to work when calculating the number of days absent from work.
The DWC
NOTE: With few exceptions, upon your request, you are entitled to be informed about information
DWC005 Rev. 02/18 |
Page 3 of 3 |