indiana workers comp exemption template

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the indiana department of revenue issues worker’s compensation exemption certificate clearance to individual taxpayers who are independent contractors or otherwise not required to carry worker’s compensation insurance on themselves under the worker’s compensation act of indiana. the certification is filed for you with the indiana worker’s compensation board to obtain your independent contractor status. you are required to pay a $20 fee, $5 (non-refundable) to the indiana department of revenue and $15 to the indiana worker’s compensation board, for making the application. worker’s compensation board of indiana clearance certificate application – (english); workers compensation clearance certificate application – (spanish) indiana department of revenue / worker’s compensation board of indiana 22–3–7–9 (b)(2) and am thereby exempted from worker’s compensation coverage. find workers compensation insurance forms for indiana. with no employees or an sole officer of a corporation and would like to be exempt from coverage.

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