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In Oklahoma, the Exempt Status form plays a crucial role for individuals and businesses seeking to clarify their status under the Administrative Workers' Compensation Act (AWCA). This form allows eligible parties to assert that they do not fall under the definition of “employee” and can therefore operate without the requirement of workers’ compensation insurance. When filing the form, applicants must first establish their exempt status, typically by providing specific information regarding their business operations and understanding the distinctions between employees and independent contractors. Notably, the form comes with a nonrefundable filing fee and must be renewed every two years if the exempt status continues to apply. By signing the affidavit, individuals assert their comprehension of the legal definitions at play and acknowledge their rights and responsibilities, including the potential need to reinstate workers’ compensation coverage should their situation change. It is vital for those completing the form to ensure that the information is accurate, as providing false information can lead to significant legal repercussions. Understanding this form not only safeguards one's business interests but also ensures compliance with state regulations.

Oklahoma Exempt Example

THIS SPACE FOR COMMISSION USE ONLY

CC-FORM-36A

WORKERS’ COMPENSATION COMMISSION

 

1915 NORTH STILES AVENUE STE 231

File original and one (1) copy with the

OKLAHOMA CITY, OK 73105

Workers’ Compensation Commission

 

(WCC) in-person or by mail, or file online at

 

www.ok.gov/wcc.

AFFIDAVIT OF EXEMPT STATUS UNDER THE

Must be accompanied by a nonrefundable

$50 filing fee payable to the WCC.

ADMINISTRATIVE WORKERS' COMPENSATION ACT

CHECKS WILL NOT BE ACCEPTED.

 

Type of Filing (check one):  Original Affidavit of Exempt Status - Expires at midnight two (2) years from the filing date.

Renewal - Expires at midnight two (2) years from the expiration date indicated below.

If renewing a current Affidavit, provide: Affidavit # __________ and Expiration Date: _____________

I, ________________________________________, state under penalty of perjury, as follows:

1.I, ____________________________________ (Name of individual), in my individual capacity or operating as

_________________________________ (business name), have read, signed and attached the Exempt Status Fact Sheet and understand the definition of "employee" and specific exceptions to that definition found in 85A O.S. §2(18). I also understand that an Independent Contractor is one who engages to perform certain services for another, according to his own manner, method, free from control and direction of his contractor in all matters connected with the performance of the service, except as to the result or product of the work. A Contractor may be either (i) the owner of a project or job or (ii) an Independent Contractor in any tier who has subcontracted with a subcontractor.

2.I understand that based upon the representations in this Affidavit of Exempt Status ("Affidavit"), I am reques�ng that the recipient of this Affidavit consider my business to either (i) be exempt from the defini�on of “employee” or (ii) be that of an independent contractor, and that no workers' compensa�on insurance premium be charged for the services performed by my business. I do not want workers’ compensa�on insurance and understand that I am not eligible for workers’ compensa�on benefits.

3.In the event changed circumstances make securing compensation pursuant to the requirements of the Administrative Workers' Compensation Act necessary, I will execute and file a Cancellation of Affidavit of Exempt Status with the Workers' Compensation Commission. I will obtain workers’ compensation and employers’ liability insurance for my employees if I have employees, unless they are otherwise exempt from the requirements of the Administrative Workers’ Compensation Act.

4.The information I have provided is not the result of force, threats, coercion, compulsion or duress.

5.I understand that the execution of this Affidavit, if I am an independent contractor, shall establish a conclusive presumption that I am not an employee for purposes of the Administrative Workers’ Compensation Act.

6.I understand that the execution of this Affidavit shall not affect the rights or coverage of any employee of the individual or business executing this Affidavit.

7.I understand if any contractor or its insurer shall become liable under the Administrative Workers’ Compensation Act for the payment of compensation due to a compensable work related injury of my employee(s), the contractor or its insurer may recover from me the amount of such compensation paid or for which liability is incurred.

8.I understand that knowingly providing false information on an executed Affidavit of Exempt Status shall constitute a misdemeanor punishable by a fine not to exceed One Thousand Dollars ($1,000.00).

Affiant Signature

I declare under PENALTY OF PERJURY that I have examined all statements contained herein, and to the best of my knowledge and belief, they are true, correct and complete.

Affiant Name ______________________________________ Title ________________________ Phone _____________________

Business Name ____________________________________________________ Email ___________________________________

FEIN/EIN/TIN # _______________ Mailing Address ________________________________________________________________

Affiant Signature _________________________________________________________________ Date _____________________

Any person who commits workers’ compensation fraud, upon conviction, shall be guilty of a felony punishable by imprisonment, a fine or both.

It is a crime to falsify the information on this form.

Effective 1/2/19

EXEMPT STATUS FACT SHEET

Pursuant to 85A O.S., §36, any individual or business entity that is not required to secure compensation under the requirements of the Administrative Workers' Compensation Act (AWCA) may execute an Affidavit of Exempt Status. Those who are unsure as to whether they may lawfully submit an Affidavit of Exempt Status should seek competent legal advice.

Employee: 85A O.S., §2(18): The definition of "employee" includes any person, including minors, in the service of an employer under any contract of hire or apprenticeship, written or oral, expressed or implied. It excludes those whose employment is casual and not in the course of the trade, business, profession, or occupation of his or her employer. Additional, specific exceptions may be found in 85A O.S. §2(18)(b).

Independent Contractor: The AWCA does not define "independent contractor." Oklahoma law considers an independent contractor to be one who engages to perform certain services for another, according to his or her own manner and method, free from control and direction of his or her contractor in all matters connected with the performance of the service, except as to the result or product of the work. Independent Contractors are not “employees” for purposes of the AWCA.

Below are statements to help you decide if you are an independent contractor. No one statement is controlling, and your status is based on all the facts in your situation.

1.The nature of the contract between you and the contractor. For example: Is there a writen contract where you agree that you are an independent contractor? Are you a corpora�on or limited liability company? Do you maintain commercial general liability insurance or other business insurance?

2.The contractor exercises very litle control over your work. For example: By the agreement, can the contractor exercise control on the details of the work or your independence? Do you exercise control over most of the details of the work? Do you create plans or specifica�ons for the job? Do you set your own work hours?

3.You are engaged in a dis�nct occupa�on or business for others. For example: Do you work for companies or individuals other than the Contractor? Do you work for compe�tors of the Contractor? Does your business have a logo or uniform?

4.Your job is the kind of occupa�on where the work is usually performed by a specialist without supervision, and not under the direc�on of the contractor. For example: Does the Contractor supervise your work?

5.Your occupa�on requires special skills, license, educa�on or training.

6.The contractor does not supply the things needed to perform your job such as the tools and the place of work. For example: Do you supply any of the materials or tools for the work? Do you operate a vehicle owned by the contractor? Do you perform the work at your business or the contractor’s business loca�on or jobsite? Do you wear a uniform supplied by the contractor?

7.The length and dura�on of the job does not show that you are really an employee. For example: Is this a one-�me job, or will you be doing this for the contractor regularly?

8.You are paid as a separate contractor, not as an employee. For example: Do you invoice the Contractor for your services? Are you paid by the job? Do you file a federal income tax return for your business? Do you expect to receive an IRS Form 1099 from the Contractor? Does the Contractor pay your expenses?

9.Your work is not the regular business of the employer. For example: Is your work customarily done in the Contractor’s line of business or as part of the Contractor’s daily work? Have you ever been an employee of the Contractor? Do you work with other people hired by the Contractor on the work you perform?

10.You do not consider yourself an employee of the contractor. For example: Will the Contractor withhold taxes or monies from your payment? Have you ever been an employee of the Contractor? Have you or your employees ever filed an insurance claim against the Contractor?

11.You do not have the right to terminate the rela�onship without liability. For example: If you quit before the job is finished, is there a penalty?

It is a crime to falsify the information on this form.

Effective 1/2/19
Get Oklahoma Exempt PDF Form

Form Characteristics

Fact Name Details
Purpose of the Form The Oklahoma Exempt Form is used to declare an individual's or business entity's exempt status from workers' compensation requirements under the Administrative Workers' Compensation Act.
Governing Law This form is governed by the Administrative Workers' Compensation Act, specifically as outlined in 85A O.S. §36.
Filing Fee A nonrefundable filing fee of $50 is required when submitting the Affidavit of Exempt Status, payable to the Workers' Compensation Commission.
Validity Period The original Affidavit expires at midnight two years from the filing date. Renewals also expire two years from their previous expiration date.
Independent Contractors To qualify as an independent contractor, one must operate freely without control from the contractor, according to his or her method of doing work, unless pertaining to the result of that work.
False Information Penalty Providing false information on the Affidavit is considered a misdemeanor and can lead to a fine of up to $1,000.
Affidavit Requirements The affiant must declare under penalty of perjury that the statements made are true and should sign the document accordingly.
Exception for Employees The execution of this Affidavit does not affect the rights or coverage of any employees of the individual or business filing it.

Guidelines on Utilizing Oklahoma Exempt

Once you have gathered all the necessary information, you are ready to fill out the Oklahoma Exempt form. Following these steps will ensure that you complete the form correctly and submit it in the appropriate manner. Be sure to check that all details are accurate, as any discrepancies may lead to delays or issues with your filing.

  1. Visit the Oklahoma Workers’ Compensation Commission website at www.ok.gov/wcc or obtain a physical copy of the form from their office.
  2. Fill out the top section, including your name and contact information. Be sure to specify whether you are filing an original affidavit or a renewal.
  3. Provide your business name if applicable, and ensure you include your FEIN/EIN/TIN number, phone number, and email address.
  4. Write the Affidavit number and the expiration date if you are renewing an existing affidavit.
  5. Review and complete the declarations, stating your understanding of your status as an independent contractor or exemption from employee classification.
  6. Sign and date the Affidavit, indicating that you understand the penalties for providing false information.
  7. Prepare a nonrefundable $50 filing fee, payable to the Workers’ Compensation Commission. Note that checks will not be accepted.
  8. Choose your method of submission: you can file the original and one copy in-person, by mail, or online at the Workers’ Compensation Commission website.

After submitting your completed form along with the filing fee, the Workers' Compensation Commission will process your application. Keep an eye on any correspondence from them regarding your filing status or additional requirements. Make sure to retain copies of your submitted documents for your records.

What You Should Know About This Form

What is the purpose of the Oklahoma Exempt Form?

The Oklahoma Exempt Form, specifically the Affidavit of Exempt Status, allows individuals or businesses to declare their exemption from the definition of "employee" under the Administrative Workers' Compensation Act (AWCA). By submitting this form, applicants request that they not be required to obtain workers' compensation insurance. It is essential to understand that filing this form means you acknowledge you are not eligible for workers' compensation benefits.

Who should file an Oklahoma Exempt Form?

This form is intended for individuals or business entities that believe they do not need to secure compensation under the AWCA. Typically, this includes independent contractors who perform work without being under the control and direction of an employer. Those unsure about their eligibility for filing should seek competent legal advice to understand their status better.

What is the filing process for the Oklahoma Exempt Form?

To file the Oklahoma Exempt Form, you must complete the affidavit and submit the original and one copy to the Oklahoma Workers' Compensation Commission (WCC). You can file in person, by mail, or online at the WCC website. A critical requirement is that the form must be accompanied by a nonrefundable $50 filing fee, payable to the WCC. Please note that checks are not accepted.

How long is the exemption valid after filing?

An original Affidavit of Exempt Status remains valid for two years from the filing date. If you need to renew the affidavit, it will remain valid for another two years from the expiration date of the previous filing. Renewal also involves submitting a new affidavit with the required information, including the previous Affidavit number and expiration date.

What happens if my circumstances change after filing?

If your situation changes in a way that requires you to obtain workers’ compensation coverage, you must file a Cancellation of Affidavit of Exempt Status with the WCC. Additionally, if you do have employees, you are required to obtain workers' compensation and employers’ liability insurance unless those employees are exempt from the requirements outlined in the AWCA.

What are the consequences of providing false information on the form?

Falsifying information on the Oklahoma Exempt Form is considered a serious offense. Knowingly providing false details can lead to misdemeanor charges, with penalties including a fine of up to $1,000. Furthermore, actions categorized as workers’ compensation fraud can escalate to felony charges, which may result in imprisonment, fines, or both. Therefore, it is crucial to provide accurate and truthful information when completing the affidavit.

Common mistakes

Filling out the Oklahoma Exempt form can be straightforward. However, many people make mistakes that can lead to delays or rejections. One common mistake is failing to sign the form. Without a signature, the application is incomplete and cannot be processed. Always ensure your signature is clearly placed where it is required, as this verifies your acknowledgment of the statements made.

Another frequent error is not providing all the necessary personal information. The form requires details like your name, business name, and contact information. Omitting any of this can lead to confusion. If reviewers cannot easily identify the applicant, it can result in significant processing delays.

Submitting the wrong type of filing is another trap many fall into. The form has options for submitting an original affidavit or a renewal. Not checking the appropriate box can cause delays or lead to the form being returned. Be sure to review the options carefully before submitting.

People often underestimate the importance of understanding the definitions within the form. Misunderstanding what constitutes an "employee" versus an "independent contractor" can lead to filing errors. Read the definitions thoroughly to ensure you accurately represent your relationship with the contractor or business.

Not including the required filing fee is also a common error. The form specifically states that a nonrefundable fee of $50 must accompany submissions. If the fee isn't included, the form may not be processed, causing additional delays. Checks are not accepted, so be sure to pay the fee using the specified method.

Some individuals forget to attach the Exempt Status Fact Sheet. This document is crucial as it provides essential definitions and context for your claims. Ensure that this sheet is attached to your affidavit for a smoother review process.

Inaccurate information can be a significant issue. Providing false details, whether intentional or accidental, can have serious consequences. Always double-check the information for accuracy. Even small errors can lead to complication and confusion.

Many applicants also neglect to update their information. If your business or personal details change, it's important to file a Cancellation of Affidavit of Exempt Status. Failing to do so can put you at risk in case of a dispute or insurance claim.

Lastly, misunderstanding the implications of this affidavit can lead to poor decisions. Individuals must realize that filing this form means they are waiving their rights to certain compensations. Understanding this fully can inform your decision to file, ensuring it aligns with your business practices.

By avoiding these common mistakes, individuals can navigate the Oklahoma Exempt form process more effectively. Proper preparation and careful attention to detail are key to successful filing.

Documents used along the form

The Oklahoma Exempt form is a crucial document for individuals and businesses claiming exemption from Workers' Compensation coverage under the Administrative Workers' Compensation Act. Alongside the Exempt form, there are several other documents and forms frequently utilized within this process. Below are eight documents commonly associated with the Oklahoma Exempt form, each serving a specific purpose in the workers' compensation framework.

  • Cancellation of Affidavit of Exempt Status: This form is used to withdraw the previously submitted Affidavit of Exempt Status. It is essential for anyone who wishes to change their status and obtain workers' compensation coverage after initially opting out.
  • Workers' Compensation Insurance Application: This form is required when an individual or business decides to secure workers' compensation insurance. It collects relevant information and establishes the necessary coverage.
  • Employer's First Report of Injury: Employers must complete this report to document any work-related injuries to employees. This helps initiate the workers' compensation claim process and tracks injury statistics.
  • Annual Payroll Report: This document details an employer's payroll for the year. It's important for determining workers' compensation premiums based on payroll amounts and classifications of jobs.
  • Employee Acknowledgment of Exempt Status: This form is used to inform employees about a contractor's exempt status or independent contractor classification, ensuring transparency about workers’ compensation coverage.
  • Independent Contractor Agreement: This contract outlines the terms and conditions of the relationship between a contractor and a client. It often includes provisions that stress the independent status of the contractor regarding workers' compensation.
  • Verification of Coverage: This form verifies that existing workers’ compensation insurance is in effect. It may be requested by various parties to confirm compliance with legal requirements.
  • Workers' Compensation Claims Form: This document is used to officially file a claim for benefits after an injury occurs. It is crucial for employees seeking compensation for work-related incidents.

In conclusion, understanding these additional documents is vital for anyone navigating the workers' compensation landscape in Oklahoma. Properly managing the interaction between these forms can facilitate compliance and protect against potential liabilities. Stay informed and ensure all documentation is completed accurately to avoid any issues.

Similar forms

  • Affidavit of Exempt Status (Texas): The Texas version serves a similar purpose as the Oklahoma Exempt Form. Both documents allow individuals or businesses to declare their exemption from workers' compensation insurance, emphasizing that they are operating as independent contractors rather than employees. This declaration also highlights the essence of liability; if the exemption is misrepresented, both forms impose serious legal consequences.
  • Employer's Certificate of Exemption (California): In California, this certificate functions to certify that an employer is exempt from providing workers' compensation insurance coverage. Like its Oklahoma counterpart, it involves submitting proof and completing an affidavit that outlines the business structure and relationships with employees and contractors.
  • Notice of Employer's Exemption from Workers' Compensation (Florida): Florida companies can file this notice to assert their status as exempt from workers' comp laws due to specific circumstances, such as having fewer than four employees. Both Florida's notice and the Oklahoma form convey essential information about the nature of employment and the lack of coverage for workers’ compensation benefits.
  • Independent Contractor Agreement (General): This agreement spells out the terms between a contractor and a business, making it clear that the contractor is not an employee. Although it isn’t a government form, it serves to establish the contractor's status, echoing the core purpose of the Oklahoma Exempt Form in defining independent contractor relationships and understanding legal boundaries.

Dos and Don'ts

  • Do read the Exempt Status Fact Sheet thoroughly before filling out the form. Understanding the definitions and requirements is crucial to completing the form accurately.
  • Do ensure that all personal and business information is complete and correct. Double-check your contact details, including phone number and email, to avoid issues later.
  • Do submit the form with the required $50 nonrefundable filing fee. Be mindful that checks are not accepted; use an alternative payment method as stated.
  • Do sign the Affidavit under penalty of perjury. This acknowledges that you understand the implications of your declaration.
  • Don't provide false information on the form. This can lead to severe consequences, including fines and possible charges of workers’ compensation fraud.
  • Don't assume you qualify for exemption without assessing your specific situation. If in doubt, consult with a knowledgeable legal advisor for guidance.

Misconceptions

  • Misconception 1: The Oklahoma Exempt Form guarantees immediate exemption from workers’ compensation insurance.

    • This form does not guarantee exemption. It serves as an official affidavit that must be filed and approved, considering specific qualifications.

  • Misconception 2: Anyone can fill out the Exempt Form and be considered an independent contractor.

    • This is incorrect. Only individuals or businesses that meet specific criteria can be deemed independent contractors. A thorough understanding of your working relationship is essential.

  • Misconception 3: Filing the form means you will always remain exempt from workers’ compensation.

    • The exemption lasts only for two years. It must be renewed, and any changes in your working conditions or relationships may affect your status.

  • Misconception 4: If you file the Exempt Form, you are entitled to workers’ compensation benefits.

    • This is not true. By filing, you acknowledge your desire not to have workers’ compensation insurance and understand that you are not eligible for its benefits.

  • Misconception 5: The Exempt Form is the same as having business insurance.

    • The Exempt Form is not a substitute for business insurance. It does not provide any coverage; it merely states your exemption status under the law.

  • Misconception 6: The Exempt Form eliminates all liability regarding workplace injuries.

    • This form does not absolve you of liability. If an injured employee claims compensation, other contractors may seek recovery from you for amounts paid.

  • Misconception 7: You do not need to seek legal advice before filing the Exempt Form.
  • Misconception 8: Providing false information on the Exempt Form is a minor issue.

    • Providing false information is serious and can lead to criminal charges, including fines and imprisonment. Misrepresentation is not taken lightly.

  • Misconception 9: The Exempt Form is solely for businesses, not for individual contractors.

    • This form is applicable to both individuals and businesses. It serves as a means for any entity that meets the criteria to establish their exempt status.

Key takeaways

When it comes to filling out and using the Oklahoma Exempt form, understanding the key aspects can help ensure a smooth process. Here are ten important points to keep in mind:

  1. Filing Methods: You can file the original form and one copy either in person or by mail with the Oklahoma Workers’ Compensation Commission. There’s also an option to file online at www.ok.gov/wcc.
  2. Filing Fee: A nonrefundable fee of $50 must accompany the affidavit. Be aware that checks are not accepted, so plan accordingly.
  3. Understanding Status: The form allows individuals or businesses to declare their status as either exempt or an independent contractor. It’s crucial to understand what each status entails.
  4. Expiration: Original affidavits expire at midnight two years from the filing date. Keep track of your expiration date to ensure compliance.
  5. Changing Circumstances: If your situation changes, you’ll need to file a Cancellation of Affidavit of Exempt Status to secure workers’ compensation if necessary.
  6. Penalties for Misrepresentation: Knowingly providing false information can lead to significant penalties, including fines up to $1,000 and even felony charges for fraud.
  7. Independent Contractor Definition: Ensure you understand the characteristics of an independent contractor, as these criteria will help in determining your correct status.
  8. Rights and Coverage: Executing the affidavit won’t affect the rights or coverage of employees related to the individual or business filing the affidavit.
  9. Inevitability of Liability: If a contractor becomes liable for your employee’s work-related injury, they can seek compensation from you if you’ve misrepresented your status.
  10. Consultation Recommended: If you are unsure whether you should submit the exemption form, consider seeking legal advice for clarity.

Becoming familiar with these points will help streamline your experience with the Oklahoma Exempt form and ensure you are making informed decisions in compliance with the law.

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