Help for Requesting an Attestation of Exemption

A Request for Attestation of Exemption can be completed on-line by applicants who are not required to carry NYS workers' compensation and/or disability and paid family leave benefits insurance coverage.

A Request for Attestation of Exemption can be completed on-line by applicants who are not required to carry NYS workers' compensation and/or disability and paid family leave benefits insurance coverage.

The Certificate of Attestation of Exemption can ONLY be used to attest to a government entity that an applicant requesting a permit, license or contract from that government entity is not required to carry NYS workers' compensation and/or disability and paid family leave benefits insurance coverage.

Effective September 9, 2007, all out-of-state employers with employees working in NYS are required to carry a full, statutory NYS workers' compensation insurance policy.

Certificates of Attestation of Exemption contain a unique certificate number used by government officials to verify the validity of the certificate.

Certificates are only valid for the specific license, permit or contract and the period for which it is issued. Certificates for buiding permits are job specific and a separate certificate will be required for each building permit.

Table of Contents
Information

1. Helpful Information
2. Technical Information
3. Getting Started
4. List of Certificates
5. Applicant Personal Information
6. Legal Entity Information
7. Permit/License/Contract Information
8. Workers' Compensation Coverage Exemptions
9. Disability and Paid Famliy Leave Benefits Coverage Exemptions
10. Certificate Submission
11. Contact Information

• There is a link at the top of each page that will help explain in detail the information required to Request a Attestation of Exemption.
• When moving from page to page always use the buttons on the page that contains the information. Do not use the browser toolbar "Back" and "Forward" buttons to navigate the pages.

• Pop-up Blocker: If Pop-Up Blockers are enabled, certain messages, and viewing and printing of the Certificate of Attestation of Exemption will not display. Please adjust your browser setting to allow Pop-ups for this web site. For additional information regarding Pop-up Blockers, see your Browser's Help File.
• Download Free Adobe Reader: In order to be able to view the results as a PDF, you will need a PDF viewer. Here is a link to open a new browser window with information on how to download a FREE Adobe Reader. You must have an Adobe Reader version 4.0 or later to view the PDF Certificate of Attestation of Exemption provided upon the submission of the Request for Attestation of Exemption to New York State Workers' Compensation Board.
• If the PDF looks completely blank in your PDF viewer, left click on your browser's refresh icon to have the Certificate of Attestation of Exemption appear.
• If you are having problems printing a completed CE-200, please e-mail the Workers' Compensation Board at general_information@wcb.ny.gov or call (866) 298-7830
• For Computer Technical Support, please e-mail the Workers' Compensation Board at helpdesk@wcb.ny.gov or call (866) 298-7830.

• The combination of PIN, Mother's Maiden Name and Business Phone Number entered on the Sign On screen will be used as your unique electronic signature. This will allow you, and only you, to view and/or print other Certificates of Attestation of Exemption you have previously requested.
• If you leave the web application or close the browser session without completing the response, only totally completed web pages, up to and including Legal Entity Information, will be saved. After the Legal Entity Information page, all information entered will be lost. You will need to start over again and complete the request, then submit the request to the New York State Workers' Compensation Board.

• Signing on to the web application:
  • Enter a 4-digit PIN - Enter a 4-digit number that will be used as part of your unique electronic signature.
  • The 4-digit PIN is not issued by the Workers' Compensation Board.
  • The 4-digit PIN is any 4-digit number you wish to enter that may be easy for you to remember for future use. Using this same PIN, Mother's Maiden Name and Business Phone Number for additional requests, will allow you to view previously submitted requests for exemptions and save you from having to re-enter some data from scratch.
  • Confirm the PIN - Re-enter the above 4-digit PIN for confirmation.
  • Mother's Maiden Name - Enter your Mother's Maiden Name. This will also be used as part of your unique electronic signature.
  • Business Phone # - Enter your Business Phone Number. This will also be used as part of your unique electronic signature.
  • No Problem - Just enter a new 4-digit number, confirm this new number and complete the remainder of the sign on screen.
    • This new PIN along with the data you enter for Mother's Maiden Name and Business Phone Number will now become your unique electronic signature.
    • Since your unique electronic signature is based on the combination of PIN, Mother's Maiden Name and Business Phone Number, previously submitted requests for exemptions under the old PIN will not display when entering the new PIN.
    • If you experience problems signing on to the Request for Attestation of Exemption web application,contact us.
    • Certificates of Attestation of Exemption are only valid for the specific license, permit or contract and the period for which it is issued. Certificates for building permits are job specific and a separate certificate will be required for each building permit. Based on your unique electronic signature, if you previously completed a request for an exemption, upon signing on to the web application, you will be directed to a list of all your previous Certificates of Attestation of Exemption. You will be able to view them and/or reprint them, if necessary.
    • To view or print a previously submitted request, click on the Exemption Certificate Number.
    • If you encounter problems printing a completed Certificate, please e-mail the Workers' Compensation Board at general_information@wcb.ny.gov or call (866) 298-7830
    • When requesting a New Attestation of Exemption, if a Request for a Attestation of Exemption has been submitted or previously started, the Applicant Personal Information and Legal Entity Information web pages will be pre-filled with information from your most current request. You should verify that information and make any necessary changes before continuing to the next web page.
    • The Request for Attestation of Exemption must be completed by one of the following:
      • the business owner;
      • an officer with the authority to act on behalf of the business;
      • Enter the First Name of the individual filling out this request.
      • Enter the Middle Initial of the individual filling out this request.
      • Enter the Last Name of the individual filling out this request.
      • Title refers to the position held by the individual filling out this request.
      • The Title is defaulted to Sole Proprietor. Select the Title of the individual filling out this request.
      • Select OTHER if your title is not listed and enter your title in Other Title.
      • Enter Other Title if appropriate.
      • Enter the Applicant's home street address (not the business address) in Address Line 1.
      • Enter additional address information in Address Line 2 if necessary.
      • Enter the City.
      • The State is defaulted to New York. Select another State if necessary.
      • Enter the 5-digit or 9-digit Zip Code.
      • The Country is defaulted to United States. Select another Country if necessary.
      • Enter the area code and phone number of the Applicant for contact information. Hyphens and parenthesis are not needed.
      • Enter the e-mail address of the Applicant for contact information. This is not a required field.
      • Business FEIN or SSN
        • A FEIN (Federal Employer Identification Number) is a number assigned by the Internal Revenue Service to identify a business entity. Generally, all businesses need a FEIN. You will not be able to proceed any further electronically without a FEIN or SSN (Social Security Number).
        • Enter the 9-digit Federal Employer Identification Number (FEIN) or Social Security Number (SSN) of the business. Hyphens are not needed.
        • Legal Entity is the business's legally filed name with the Department of State or County Clerk.
        • The Legal Entity Name defines the business structure of an employer such as a sole proprietorship under the employer's name or a named partnership, corporation, LLC, LLP or other business structure deemed to be "an employer" under the Workers' Compensation Law.
        • If the Applicant selects Sole Proprietor or Owner as his/her title, the Legal Entity Name will be populated with the Applicant's name. Make changes to the Legal Entity Name, if necessary.
        • Doing Business As refers to the name the business is known by or trade name.
        • Enter the Doing Business As Name (DBA) or trading as (T/A) if applicable. Usually, a sole proprietor will have a DBA name.
        • If the Applicant's address and the Business Address are the same, clicking this box will automatically pre-fill the address information and the user will not have to enter that information again.
        • Enter the Business' street address in Address Line 1.
        • Enter additional address information in Address Line 2 if necessary.
        • Enter the City.
        • The State is defaulted to New York. Select another State if necessary.
        • Enter the 5-digit or 9-digit Zip Code.
        • The Country is defaulted to United States. Select another Country if necessary.
        • Enter the area code and phone number of the Business. Hyphens and parenthesis are not needed.
        • Enter the e-mail address of the Business. This is not a required field.
        • Nature of Business
          • Nature of Business refers to the type of work being performed (i.e., construction, plumbing, restaurant, speech-language pathologist, etc.).
          • Select the Nature of Business.
          • Select OTHER if business type is not listed and enter the type of work being performed in Other Business Type.
          • Enter Other Business Type if appropriate.
          • Select the type of permit, license or contract being requested.
          • Select OTHER if permit, license or contract type is not listed and enter what you are applying for in Other Type of Request.
          • Enter Other Type of Request if appropriate.
          • Enter the governmental agency issuing the permit, license or contract.
          • If applicant's Nature of Business is Performing Artists used by Film/TV/Radio/Theater or the Type of Permit applicant is applying for is Child Performers or Filming Production (NYC), he/she will be directed to the Performing Arts Exemption web page.
          • To receive a Performing Arts Exemption, please contact the Workers' Compensation Board's Bureau of Compliance at (518) 486-6307.
          • If applicant is applying for a Building Permit, Electrical Permit or Plumbing Permit, he/she will be directed to the Job Site Location Information web page to gather additional information relating to the location of the work to be done and estimated timeframe.
          • Certificates for building permits, electrical permits and plumbing permits are job specific and must list the physical location of where the work will be performed.
          • Project From Date
            • The date the work is expected to begin. This date cannot be before the current date.
            • The date the work is expected to be completed. This date cannot be more than one year from the beginning of the project.
            • Select a dollar range which reflects estimated costs.
            • Enter the street address of the location of the work to be done.
            • Enter additional address information in Address Line 2 if necessary
            • Enter the City of the location of the work to be done.
            • The State is defaulted to New York.
            • Enter the Zip Code of the location of the work to be done.
            • Enter the County of the location of work to be done.
            • Please note: Either the Zip Code or the County must be entered. Both cannot be blank.
            • If applicant is applying for Taxi Licenses to Operate, he/she will be directed to the Taxi/Livery Guidelines web page, which lists criteria that will make the applicant ineligible for a Certificate of Attestation of Exemption.
            • If applicant meets any one of the criteria listed, there is no need to continue. The applicant can Exit the web application at this point.
            • If further help is needed, please call the Bureau of Compliance at (866) 298-7830.
            • The applicant must select ONE option which best describes why the Legal Entity is NOT required to obtain New York State specific workers' compensation insurance coverage.
            • Partner/Member Information:
              • If applicant selects option "c.) The business is a LLC, LLP, PLLC, PLLP; OR is a partnership. " on the Workers' Compensation Coverage Exemptions web page, he/she will be directed to the Partner/Member Information web page.
              • Applicant should enter the names of all the Partners/Members, including his/her own name if applicable, in First Name, Middle Initial, Last Name order.
              • Applicant can also remove a Partner/Member from the list. NOTE: Clicking the Remove Name button will remove the last name in the list.
              • If applicant selects option "e.) The business is a two person corporation. " on the Workers' Compensation Coverage Exemptions web page, he/she will be directed to the Corporate Officer Information web page.
              • Applicant should enter the names of all the Corporate Officers, including his/her own name if applicable, in First Name, Middle Initial, Last Name order and select their title.
              • Applicant can also remove a Corporate Officer from the list. NOTE: Clicking the Remove Name button will remove the last name in the list.
              OR
              • If applicant selects option "j.) The out-of-state entity has no NYS employees. " on the Workers' Compensation Coverage Exemptions web page, he/she will be directed to the Out-of-State Coverage Information web page.
              • Applicant should enter carrier and policy information including the effective and expiration dates of the policy.
              • If applicant selects option "k.) None of the above apply. " on the Workers' Compensation Coverage Exemptions web page, he/she will be directed to the Workers' Compensation Coverage Required web page.
              • If you have questions, contact the Workers' Compensation Board's Bureau of Compliance at 1-(866) 298-7830.
              • You can Exit the application at this point, if appropriate.
              • The applicant must select ONE option which best describes why the Legal Entity is NOT required to obtain New York State specific disability and paid family leave benefits insurance coverage.
              • Temporary Service Agency Information:
                • If applicant selects option "g.) Other than the business owner(s) and individuals obtained from a temporary service agency. " on the Disability and Paid Family Leave Benefits Coverage Exemptions web page, he/she will be directed to the Temporary Service Agency Information web page.
                • Applicant should enter Agency Name and Phone Number.
                • Note: If Temporary Service Agency information was already provided for the Workers' Compensation Coverage Exemptions, then it will not be necessary to provide it again. Therefore, the Temporary Services Agency Information web page will not display again.
                • If applicant selects option "h.) None of the above apply . " on the Disability and Paid Family Leave Benefits Coverage Exemptions web page, he/she will be directed to the Disability and Paid Famliy Leave Benefits Coverage Required web page.
                • If you have questions, contact the Workers' Compensation Board's Bureau of Compliance at 1-(866) 298-7830.
                • You can Exit the application at this point, if appropriate.
                • Once you have determined that the information is correct and have attested to the truth of the information being submitted, you may select the "Process and View Certificate" button. The Certificate of Attestation of Exemption will be generated with an Exemption Certificate Number and Received Date. You will be able to print a copy of the Certificate of Attestation of Exemption for your records. You will need Adobe Acrobat Reader to view the Certificate. If you do not have it, you may download a free version.Please note: Once you select the "Process and View Certificate" button, you will not be able to make any additional changes electronically.
                • If you are having problems viewing the Certificate of Attestation of Exemption, check your Pop-Up Blocker settings.
                • If you are having problems using the Request for Attestation of Exemption web application:
                  • Contact The Bureau of Compliance at (866) 298-7830 Monday - Friday, 8:30 A.M. to 4:30 P.M., if:
                    • You are having difficulty understanding what information you need to complete.
                    • You are having difficulty understanding any messages or Help statements in the application.
                    • You are unsure what the directions are telling you to do.

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