Virginia > Workers Compensation
Annual Report Of Self-Insurers Payroll By City Town Or County School Boards 26B - Virginia
| Annual Report Of Self-Insurers Payroll By City Town Or County School Boards Form. This is a Virginia form and can be used in Workers Compensation . |
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Form 26B-7/6/2011 COMMONWEALTH OF VIRGINIA WORKERS' COMPENSATION COMMISSION 1000 DMV DRIVE, RICHMOND, VIRGINIA 23220 ATTN: CHIEF FINANCIAL OFFICER Annual Report of Self-Insurer's Payroll by City, Town or County School Boards Year Ended December 31, ______ Employer ________________________________________ #_____________ Pursuant to the provisions of Section 65.2-1006 of the Workers' Compensation Act, this report must be prepared upon a calendar year th basis and filed with the Workers' Compensation Commission by March 15 . SEE INSTRUCTIONS ON THE BACK. CLASSIFICATION OF OPERATIONS: (The blank spaces are to be used in reporting payroll not specifically classified below.) Total payroll for Twelve Mos. Ending December 31, _________ CLASS CODES Transportation of Pupils including repair of vehicles All professional and clerical employees All other than professional, clerical & transportation employees Other Classifications 7380 8868 9101 $ TOTAL Signed this day Date by Signature of Representative and Title of Name and Address of School Board Fed. Tax ID# This day the foregoing report is correct. Given under my hand and seal this personally appeared before me, acknowledged their signature, and made oath that day of , . My commission expires SEAL American LegalNet, Inc. www.FormsWorkFlow.com Effective 1/1/1996 FORM 26B INSTRUCTIONS Type or print, on the form, all required information. Year ended December 31, - enter the calendar year being reported. Employer - enter the name of the school board. # - enter the 5-digit employer number assigned by the Va. Workers' Compensation Commission. (See mailing label for number.) Classification of Operations - (Classification listings have been condensed. Please enter the total payroll for each classification code.) All salaries and wages paid or due officials and employees for the calendar year, together with other remuneration, if any, must be reported including amounts paid temporary and parttime employees despite the type of work done. Salaries and wages paid because of the operating of vacation and night schools must be included. The extra remuneration paid for overtime may be deducted; e.g., if time and a half is paid for overtime, the half may be deducted. · Transportation of pupils - includes bus drivers, helpers and anyone involved in maintaining the vehicles. · Professional and clerical employees - includes teachers, administrators, guidance counselors, librarians and their professional assistants, therapists, nurses and athletic coaches. · Other than professional, clerical & transportation employees - includes employees engaged in the care, custody and maintenance of buildings, grounds and equipment, nonprofessional employees of libraries, and all non-clerical cafeteria employees. · New construction work and alterations - done by employees of the School Board must be reported under the various construction classifications applicable such as masonry, plumbing, sheet metal work, etc. In reporting this payroll, if any, the blank spaces may be used for this purpose. Include a brief description of the type of work done. Enter the appropriate NCCI classification code for each type of work. Total Payroll for ... - Enter the calendar year being reported. (If reporting for a period other than a full calendar year please indicate on the form.) List the total payroll, on the corresponding line, for each classification reported. Total - Enter the total payroll for the school board operations. Notarization - All reports must be notarized and the employer's Federal Identification Number given. Please enter the name and telephone number of the person to contact if we have any questions regarding this report. Please print. Name of Contact Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com
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