Self Insurers Report Of Payroll For All Operations {SI-6}

SI-6 - SELF-INSURER’S REPORT OF PAYROLL FOR ALL OPERATIONS. This form is issued by the New York State Workers’ Compensation Board, Office of Self-Insurance. It requires self-insured employers to report annual payroll information for all operations conducted under their self-insurance authorization. The report covers the twelve-month period ending December 31 and must include classifications of work, average number of employees, and total wages for each job class—such as drivers, salespersons, executives, and clerical staff. Employers must also list the locations of all New York State workplaces and employee counts at each site. The form must be signed and affirmed under penalty of perjury by an authorized company officer. www.FormsWorkflow.com