Get Ncci Contracting Classification Premium Adjustment Online Worksheet Form

Filling out the NCCI Contracting Classification Premium Adjustment Worksheet Form is essential for employers engaged in contracting operations to ensure that their premium calculations reflect accurate pay rates and hours worked. This guide provides a detailed step-by-step approach to help users complete the form correctly and effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling out the insured's name at the top of the form. This identifies the entity applying for the premium adjustment.
3. Enter the address, including city, state, and zip code, for the insured. This information is crucial for proper processing.
4. Specify the state credit being applied for in the designated section. Remember, a separate application is required for each state.
5. Input the policy number associated with your workers' compensation insurance. This ensures that your application is linked with the correct policy.
6. Provide the policy effective date, marking the date your workers' compensation policy began.
7. Fill in the carrier's name, which is the insurance company providing your workers' compensation coverage.
8. Proceed to list each classification applicable to your contracting operations. For example, include classifications like Electrical Wiring.
9. For each classification, enter the corresponding code. This is vital for categorizing your operations correctly.
10. Report the total wages paid for each classification, ensuring that overtime and exempt payments are excluded as specified.
11. Indicate the total number of hours worked for the reported classification during the specified calendar quarter.
12. Circle the complete calendar quarter which applies to your reporting. Options include 1st, 2nd, 3rd, or 4th quarter.
13. Complete the calendar year section by indicating the appropriate year for your records.
14. Provide your signature, indicating your agreement and certification of the information reported.
15. Fill in your position and the date of submission to finalize the form.
16. Once the form is completed, save changes, download, print, or share the form as needed.

Complete your NCCI Contracting Classification Premium Adjustment online today to ensure you receive any eligible premium credits.