LaborLawCenter.com - Arkansas Application for Certificate of Non-Coverage (Form A)

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Arkansas Application for Certificate of Non-Coverage (Form A)

SKU: FFAR160 |

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Product Description

Form A is not used to exclude corporate officers. Their exclusions are handled directly by an agent/carrier.
The Form A application is designed to allow certain individuals to remove themselves from workers’ compensation coverage.
If the answer is yes to any questions on Form A, the application will be rejected unless applicants take the form to their agents, who can provide proof of coverage for the applicant’s employees.
The current processing fee for applications is $50 in the form of a check or money order. Cash should NOT be mailed.
Form A, along with the check and notary statement, should be mailed to the Operations/ Compliance Division, AWCC, P.O. Box 950, Little Rock, AR 72203-0950 or taken to 324 Spring St., Little Rock, AR 72201.
Applications are processed within 10 working days.

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