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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 for coverage of state agencies or political subdivisions in Ohio.
Q: Who is required to use Form U-69 (BWC-7573)?
A: State agencies or political subdivisions in Ohio are required to use Form U-69 (BWC-7573) to obtain workers' compensation coverage.
Q: What is the purpose of Form U-69 (BWC-7573)?
A: The purpose of Form U-69 (BWC-7573) is to establish and document the agreement between the state agency or political subdivision and the Ohio Bureau of Workers' Compensation (BWC) for workers' compensation coverage.
Q: Is Form U-69 (BWC-7573) mandatory?
A: Yes, for state agencies or political subdivisions in Ohio, Form U-69 (BWC-7573) is mandatory for obtaining workers' compensation coverage.
Q: What information is required on Form U-69 (BWC-7573)?
A: Form U-69 (BWC-7573) requires information such as the name of the state agency or political subdivision, contact information, payroll estimates, and other details related to the coverage.
Q: Are there any fees associated with Form U-69 (BWC-7573)?
A: Yes, there may be fees associated with Form U-69 (BWC-7573), such as the premium for the workers' compensation coverage based on the payroll estimates provided.
Q: Can the coverage under Form U-69 (BWC-7573) be cancelled?
A: Yes, the coverage under Form U-69 (BWC-7573) can be cancelled by either the state agency or political subdivision or the Ohio Bureau of Workers' Compensation, subject to certain conditions and requirements.
Q: What are the consequences of not filling out Form U-69 (BWC-7573)?
A: Not filling out Form U-69 (BWC-7573) can result in the state agency or political subdivision being without workers' compensation coverage, which can lead to legal and financial risks.
Q: Who can I contact for assistance with Form U-69 (BWC-7573)?
A: For assistance with Form U-69 (BWC-7573), you can contact the Ohio Bureau of Workers' Compensation or consult with legal and insurance professionals familiar with workers' compensation laws in Ohio.
Form Details:
- Released on March 22, 2023;
- 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.
