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This version of the form is not currently in use and is provided for reference only. Download this version of
Form U-69 (BWC-7573)
for the current year.
Form U-69 (BWC-7573) Contract for Coverage of State Agency or Political Subdivision - Ohio
What Is Form U-69 (BWC-7573)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form U-69 (BWC-7573)?
A: Form U-69 (BWC-7573) is a contract used for coverage of state agencies or political subdivisions in Ohio.
Q: Who uses Form U-69 (BWC-7573)?
A: State agencies or political subdivisions in Ohio use Form U-69 (BWC-7573) to obtain coverage for their employees.
Q: What is the purpose of Form U-69 (BWC-7573)?
A: The purpose of Form U-69 (BWC-7573) is to establish an agreement between the Ohio Bureau of Workers' Compensation (BWC) and the state agency or political subdivision for workers' compensation coverage.
Q: What information is required on Form U-69 (BWC-7573)?
A: Form U-69 (BWC-7573) requires detailed information about the state agency or political subdivision, its employees, payroll records, and payment instructions.
Q: Are there any deadlines for submitting Form U-69 (BWC-7573)?
A: Yes, the Form U-69 (BWC-7573) should be submitted to the Ohio Bureau of Workers' Compensation (BWC) at least 30 days before the desired effective date of coverage.
Q: What happens after submitting Form U-69 (BWC-7573)?
A: The Ohio Bureau of Workers' Compensation (BWC) will review the form and determine the appropriate premium rate for the state agency or political subdivision.
Q: Can a state agency or political subdivision choose not to use Form U-69 (BWC-7573)?
A: No, state agencies or political subdivisions in Ohio must use Form U-69 (BWC-7573) to obtain workers' compensation coverage from the Ohio Bureau of Workers' Compensation (BWC).
Form Details:
- Released on June 20, 2011;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form U-69 (BWC-7573) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
