K-WC Form 51 "Election of Employer to Cover Employees" - Kansas

What Is K-WC Form 51?

This is a legal form that was released by the Kansas Department of Labor - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2017;
  • The latest edition provided by the Kansas Department of Labor;
  • 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 fillable version of K-WC Form 51 by clicking the link below or browse more documents and templates provided by the Kansas Department of Labor.

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Download K-WC Form 51 "Election of Employer to Cover Employees" - Kansas

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KANSAS DEPARTMENT OF LABOR
www.dol.ks.gov
ELECTION OF EMPLOYER TO COVER EMPLOYEES
K-WC 51 (Rev. 1-17)
MAIL: Division of Workers Compensation
401 SW Topeka Blvd., Suite 2
Topeka, KS 66603-3105
FAX: (785) 296-0025
Election of Employer to Cover Employees Under
Kansas Workers Compensation Act, Where Employer
has less than $20,000 Payroll or is Agricultural Pursuit
To be processed, ALL entries on this form must be completed. If not completed using
the fillable form feature, entries must be neatly printed in black ink or typewritten. This
form must be signed.
This Election is effective upon receipt by the Kansas Division of Workers Compensation.
To the Kansas Division of Workers Compensation, you are hereby notified that:
Employer name: _____________________________________________________________________________
Corporate name if applicable: __________________________________________________________________
Address: ___________________________________________________________________________________
__________________________________________________________________________________________
FEIN: ____________________________ Email:____________________________________________________
Phone: (
)
___________________________ Type of business: ____________________________________________
hereby elects to come within the provisions of the Kansas Workers Compensation Act pursuant to
K.S.A. 44-505(b).
Signature of employer or authorized representative
Title
Date
DIVISION OF WORKERS COMPENSATION
401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 • Phone (785) 296-4000 • Fax (785) 296-0025
KANSAS DEPARTMENT OF LABOR
www.dol.ks.gov
ELECTION OF EMPLOYER TO COVER EMPLOYEES
K-WC 51 (Rev. 1-17)
MAIL: Division of Workers Compensation
401 SW Topeka Blvd., Suite 2
Topeka, KS 66603-3105
FAX: (785) 296-0025
Election of Employer to Cover Employees Under
Kansas Workers Compensation Act, Where Employer
has less than $20,000 Payroll or is Agricultural Pursuit
To be processed, ALL entries on this form must be completed. If not completed using
the fillable form feature, entries must be neatly printed in black ink or typewritten. This
form must be signed.
This Election is effective upon receipt by the Kansas Division of Workers Compensation.
To the Kansas Division of Workers Compensation, you are hereby notified that:
Employer name: _____________________________________________________________________________
Corporate name if applicable: __________________________________________________________________
Address: ___________________________________________________________________________________
__________________________________________________________________________________________
FEIN: ____________________________ Email:____________________________________________________
Phone: (
)
___________________________ Type of business: ____________________________________________
hereby elects to come within the provisions of the Kansas Workers Compensation Act pursuant to
K.S.A. 44-505(b).
Signature of employer or authorized representative
Title
Date
DIVISION OF WORKERS COMPENSATION
401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 • Phone (785) 296-4000 • Fax (785) 296-0025