Get Pa Workers Compensation Information Form 2017-2025

Filling out the PA Workers Compensation Information Form online is a critical step for individuals and contractors in Pennsylvania who need to confirm their exemption from workers' compensation insurance. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the PA Workers Compensation Information Form online.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by reviewing the affidavit of exemption section. You will need to select one of the provided reasons that apply to your situation regarding the requirement of workers’ compensation insurance.
3. If you are a property owner performing your own work, indicate this by checking the first box. Remember, if you hire contractors for any tasks under the building permit, you must ensure they provide proof of workers’ compensation insurance to the municipality.
4. For contractors with no employees, mark the second box. It is essential to understand that you are prohibited from employing individuals for work unless you provide proof of insurance to the municipality.
5. If you believe you qualify for a religious exemption under the Workers’ Compensation Law, check the third box. Attach copies of exemption letters for all employees as required.
6. Complete the signature section by providing your signature as the applicant, along with the county and municipality where you are submitting the form. Ensure that it is filled out accurately.
7. This form must be notarized. Look for the notary public section where you will need to sign in front of a notary, and they will provide their signature and seal. Date the form accurately.
8. Once all fields are completed, save your changes. You can choose to download, print, or share the form as necessary.

Complete your forms online today and ensure your compliance with Pennsylvania workers' compensation requirements.