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Form LIC04 Certificate of Compliance - Minnesota Workers' Compensation Law - Minnesota
What Is Form LIC04?
This is a legal form that was released by the Minnesota Department of Labor and Industry - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form LIC04?A: Form LIC04 is a certificate of compliance for the Minnesota Workers' Compensation Law in Minnesota.
Q: What is the purpose of Form LIC04?A: The purpose of Form LIC04 is to certify that an employer has workers' compensation coverage as required by law.
Q: Who needs to fill out Form LIC04?A: Employers in Minnesota who have workers' compensation coverage need to fill out Form LIC04.
Q: Is Form LIC04 mandatory?A: Yes, Form LIC04 is mandatory for employers in Minnesota with workers' compensation coverage.
Q: What information is required on Form LIC04?A: Form LIC04 requires information about the employer's business name, address, policy number, and the effective and expiration dates of the workers' compensation coverage.
Q: Is there a fee for submitting Form LIC04?A: No, there is no fee for submitting Form LIC04.
Q: Is there a deadline for submitting Form LIC04?A: There is no specific deadline for submitting Form LIC04, but it should be filled out and submitted as soon as the employer acquires workers' compensation coverage.
Form Details:
- Released on November 1, 2016;
- The latest edition provided by the Minnesota Department of Labor and Industry;
- 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 Form LIC04 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Minnesota Department of Labor and Industry.
