Get Form Ss 4523

Filling out the Form Ss 4523, the initial workers’ compensation exemption registration application, online is a straightforward process. This guide will provide step-by-step instructions to help you successfully complete the form while ensuring compliance with the necessary requirements.

Follow the steps to fill out the Form Ss 4523 online:

1. Click the ‘Get Form’ button to retrieve the form and open it in your preferred digital document editor.
2. Enter the applicant information, including the full legal name, date of birth, the last four digits of the Social Security Number, and contact details such as phone number and email address.
3. Provide the physical address where the applicant can be reached, ensuring that it is not a post office box. If mailing is also required, enter the mailing address accurately.
4. Select the initial qualification that applies to the applicant. Ensure only one qualification is checked, as per eligibility criteria.
5. Fill in the business entity details, including the exact business name as it appears with the Secretary of State and the Secretary of State Control number.
6. Enter the Federal Employer Identification Number (FEIN). If you do not have a FEIN, refer to the IRS to obtain one before proceeding.
7. Indicate whether the business has an active contractor’s license or not, and provide the necessary license details if applicable.
8. Complete any required local business license information, providing relevant details, and marking if it is not required.
9. Check the boxes in the attestation section to confirm understanding of the requirements and to agree to the conditions regarding workers' compensation exemption.
10. Ensure the form is signed and dated by the applicant before submission.
11. After all sections are completed, save any changes made to the document. You can then download, print, or share the completed form as needed.

Complete and submit your Form Ss 4523 online through the available filing options today.