Overview

This application is for a Certificate of Attestation of Exemption, Form CE-200, from Workers' Compensation and/or Disability Benefits insurance coverage. It may only be completed by entities with no employees and/or out-of-state entities obtaining a contract or license in which all the work is being performed outside of New York State.

The application can be completed by using either the "Web-based Application" or the "Paper Application". By accessing the application on-line you will be able to complete the application and print the certificate immediately. The paper application must be submitted to the Workers' Compensation Board for processing and the certificate will be mailed to the applicant. This process may take up to 4 weeks for completion.

• Certificates can only be used to attest to a government entity that the applicant requesting a permit, license, or contract is not required to carry workers' compensation and/or disability benefits coverage.
• Certificates 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.
• Certificates are assigned a unique certificate number that can be validated by the government official issuing the license, permit, or contract.