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Video instructions and help with filling out and completing www tdi texas gov forms
This video is for the DWC forum 5 the employer notice of no coverage or termination of coverage an employer who does not have workers compensation insurance is called a non subscriber the forum 5 must be filed if you are a non subscriber unless your employees are exempt from coverage under the Texas Workers Compensation Act or if you terminate workers compensation insurance coverage nonsubscribers must file the dwc form 5 each year between February 1st and April 30th or within 30 days of hiring your first employee if you hired them on a day outside February 1st and April 30th you must also file the form within 10 days of receiving a request from TDI DWC there are several ways to file this form you may complete the form online then print it you may also complete the paper form once you have a completed hardcopy mail or fax it to the division of workers compensation we prefer you to complete the form online through the TDI website go to the division of workers compensation online and select to file online once you have completed the required fields select the submit button the form will be filed and you will receive a confirmation number letting you know it has been received the link for online filing will be repeated at the end of this video if you are using the form 5 to notify the division that you have terminated coverage you must file the form within 10 days after notifying the insurance carrier of the termination of coverage unless you purchase a new policy or become a certified self insurer if you do not purchase a new policy you become a non subscriber and you must file the form five each year during the February 1st to April 30th filing period you also must notify your employees that workers compensation insurance is not provided instructions for doing that are on page 2 of the form when you file the form you must complete all required information let's review how to complete a few of the boxes on the form the first section contains required statements tell us why you are submitting this form are you telling us you do not have workers compensation coverage or are you notifying us that you have just terminated coverage check one of the two boxes if you have terminated coverage you must also complete the policy information fields just above number two in section one there is another field you must complete we need to know the beginning date and the ending date for the statement you are making enter the effective from date and to date in the boxes the dates you enter may not exceed a one-year period for each form submitted for example if you elect not to have coverage from September 15th 2014 to April 30th 2016 you will need to file two forms the first form will use the beginning date of September 15th 2014