VA VWC 61-A 2014 free printable template

1-3714 Code of Virginia. Form 61 A is available online at www. workcomp.virginia.gov Return this form to the licensing authority not to the Virginia WC Commission. For questions regarding how to complete this form please contact the Commission toll-free at 1-877-664-2566 or 804 205-3586 Return your completed form to the licensing authority where your business license is obtained 61A rev 070114 To be completed by the official issuing the business license. Signature of Applicant Contractor or...

How to fill out VA VWC 61-A

How to fill out VA VWC 61-A

1. Begin with your personal information: Fill in your name, address, and contact information at the top of the form.
2. Provide details about your employment: Include the name of your employer and your position.
3. Describe the incident: Clearly state the date, time, and location of the incident that led to the claim.
4. Explain your injury or illness: Provide a detailed account of the injury or illness you are claiming, including symptoms and treatments.
5. Indicate the state of your disability: List how the injury has affected your ability to work or perform daily activities.
6. Attach necessary documentation: Include any medical reports or other supporting documents that validate your claim.
7. Review your application: Ensure all sections of the form are completed accurately before submission.
8. Submit the form: Send the completed form to the appropriate VA office as instructed on the form.

Who needs VA VWC 61-A?

1. Current or former military personnel who have incurred a work-related injury or illness during their service.
2. Veterans seeking to claim benefits for disabilities caused by their military service.
3. Employees of the Department of Veterans Affairs who wish to file a claim for workplace injuries or conditions.

• Who Needs VOC Form 61-A?
• What is VOC Form 61-A for?
• Is VOC Form 61-A Accompanied by Other Forms?
• • When is VOC Form 61-A due?
  • How Do I Fill out VOC Form 61-A?
  • Where Do I Send VOC Form 61-A?

Who Needs VOC Form 61-A?

VOC Form 61-A is officially called Contractor’s Certificate of Worker’s Compensation Insurance. It is widely used by contractors and businesses that perform their work in the Virginia state. Out of state employers must have valid Virginia coverage.

What is VOC Form 61-A for?

Generally, Certificate of Insurance is issued to provide information about worker’s insurance policy coverage to the party that has requested it. As an informative document it is rather limited in ability. Its main aim is to help companies or individuals who are hiring contractors to relieve responsibility for injuries and damages that may occur during work. With Contractor’s Certificate companies make sure that they will not be liable for possible damages. This certificate doesn’t guarantee any changes to the insurance policy, neither it bestowed nor extends the rights of the policyholder.

Is VOC Form 61-A Accompanied by Other Forms?

No additional documents are required to be attached to the certificate.

When is VOC Form 61-A due?

As the certificate serves informative purpose there is no specific due date for it. It is filled out upon request.

How Do I Fill out VOC Form 61-A?

VOC Form 61-A consists of one fillable page accompanied by instructions. In total there are fifteen fillable fields. The first one must be completed by the official issuing business license. Starting from the second field and up to the end of the Form 61-A, all information is provided by the contractor. The information includes business owner’s or contractor’s name, address, phone number, mail address that is used by the business to receive mail by the U.S. Postal Service. It is also mandatory to indicate the type of trade in which business is classified and its VEIN.  

Where Do I Send VOC Form 61-A?

Completed Form 61-A is sent to the local office where business license was obtained.

People Also Ask about

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How do I file a workers comp claim in Virginia?

You may file the claim: In person: Complete the Claim for Benefits Form and deliver it to any of our office locations. By mail: Complete the Claim for Benefits Form and mail it to: Virginia Workers' Compensation Commission, 333 E. By fax: Complete the Claim for Benefits Form and fax it to: 804-823-6956.

What is a Form 61A?

Certificate of Workers' Compensation Insurance (Form 61A)

What is proof of coverage in Virginia?

Proof of coverage shall include the name and address of the insured, the insured's federal employer identification number (FEIN), the policy number, dates of insurance coverage, the name and address of the insurer, and the insurer's identification number.

Who is required to have workers comp in VA?

1 Q: Am I required to obtain workers' compensation insurance? A: Virginia law requires that an employer who regularly employs more than two part-time or full-time employees carry workers' compensation.

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What is VA VWC 61-A?

VA VWC 61-A is a form used by the Virginia Workers' Compensation Commission for employers to report workplace injuries and incidents.

Who is required to file VA VWC 61-A?

Employers in Virginia who have employees that experience a work-related injury or illness are required to file VA VWC 61-A.

How to fill out VA VWC 61-A?

To fill out VA VWC 61-A, employers must provide accurate information regarding the injured employee, details of the injury, and any medical treatment provided.

What is the purpose of VA VWC 61-A?

The purpose of VA VWC 61-A is to document workplace injuries and initiate the workers' compensation process for claims.

What information must be reported on VA VWC 61-A?

Information that must be reported on VA VWC 61-A includes the employer's details, employee's information, description of the injury, date and location of the incident, and medical treatment details.