Form A Statement of Election and Assurances - Nebraska

What Is Form A?

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

FAQ

Q: What is a Statement of Election and Assurances?
A: A Statement of Election and Assurances is a document used in Nebraska.

Q: What is the purpose of a Statement of Election and Assurances?
A: The purpose of a Statement of Election and Assurances is to declare the intent of an organization or individual to participate in the state's workers' compensation system.

Q: Who needs to complete a Statement of Election and Assurances?
A: Any organization or individual that employs one or more workers in Nebraska and wants to be included in the state's workers' compensation system needs to complete a Statement of Election and Assurances.

Q: What information is required in a Statement of Election and Assurances?
A: A Statement of Election and Assurances typically requires basic information about the organization or individual, such as name, address, contact information, and the number of employees.

Q: Is there a deadline for submitting a Statement of Election and Assurances?
A: Yes, the deadline for submitting a Statement of Election and Assurances is usually within 30 days of the organization or individual starting to employ workers in Nebraska.

Q: What happens after I submit a Statement of Election and Assurances?
A: After you submit a Statement of Election and Assurances, your organization or individual will be included in the state's workers' compensation system.

Q: What if I don't submit a Statement of Election and Assurances?
A: If you don't submit a Statement of Election and Assurances, you may be subject to penalties and fines.

Q: Can I change my election and assurances after submitting the form?
A: Yes, you can change your election and assurances by submitting a new Statement of Election and Assurances form to the Nebraska Workers' Compensation Court.