Blank Ga 4 New York Form

1. What is the GA-4 form?

   The GA-4 form, or Quarterly Unified Employer Assessment Municipal Self-Insurers Remittance Form, is a document that municipal self-insured employers in New York must complete each quarter. It is used to report payroll information and calculate assessments for workers' compensation.

2. Who needs to file the GA-4 form?

   Every active municipal self-insured employer is required to file the GA-4 form. This includes school districts and other municipal employers. If an employer has discontinued its self-insurance program, they do not need to submit this form.

3. When is the GA-4 form due?

   The form must be submitted within thirty days of the end of each quarter. It is essential to adhere to this deadline to avoid penalties and ensure compliance with New York State regulations.

4. What information is required on the GA-4 form?

   • WCB Identification Number (W Number)
   • Name of the municipal self-insured employer
   • Federal Employer Identification Number (FEIN)
   • Mailing address
   • Payroll details categorized by employee type

   Each section must be filled out accurately to ensure proper assessment calculations.

5. How is the assessment amount calculated?

   The assessment is calculated based on the total payroll reported, multiplied by the established assessment rate. For municipal employers, the assessment rate is currently set at 13.8%.

6. What should I do if I have multiple employers under one W number?

   If there are multiple employers covered under the same W number, you must use the GA-4.1 addendum. This addendum allows you to report payroll information for each employer separately.

7. Where do I send the completed GA-4 form?

   You can submit the completed GA-4 form via email to [email protected]. Additionally, you should mail the corresponding payment to:

   New York State Workers’ Compensation Board
   328 State Street
   Finance Unit, Room 331
   Schenectady, NY 12305-2318

8. What happens if I fail to submit the GA-4 form on time?

   Failure to submit the form and payment on time may result in penalties, including interest charges on underpaid assessments. In severe cases, it could lead to the revocation of self-insured status.

Filling out the GA-4 New York form can be a straightforward task, but there are common mistakes that individuals often make. One frequent error is neglecting to include the WCB Identification Number or "W Number." This number is crucial as it uniquely identifies the municipal self-insurer. Without it, the form may be deemed incomplete, leading to potential delays in processing.

Another mistake is failing to provide the full legal name of the municipal self-insured employer. This name should match exactly with the records on file with the Workers' Compensation Board. Any discrepancies can cause confusion and may result in additional follow-up or corrections that could have been easily avoided.

People sometimes forget to report the Federal Employer Identification Number (FEIN). This number is essential for identifying the employer for tax purposes. Omitting it can lead to complications and might even result in penalties. It’s important to double-check that this number is accurate and clearly written.

Additionally, some individuals overlook the requirement to report excluded payroll not subject to assessment. If applicable, this information must be included to ensure that the total payroll is accurately calculated. Neglecting this step can skew the assessment results and lead to incorrect payments.

Another common oversight is not reconciling the total payroll reported on the GA-4 form with that on the NYS-45. If there are discrepancies, it is necessary to provide a reconciliation. Failing to do so can raise red flags during audits and complicate future submissions.

People also tend to miscalculate the total loss cost by failing to apply the correct assessment rate. This calculation is vital for determining the total assessment due. A simple math error can lead to underpayment or overpayment, both of which can have financial repercussions.

Moreover, some individuals do not submit the form and payment within the required thirty-day timeframe after the quarter ends. Late submissions can incur penalties and interest, which can add unnecessary costs. Staying organized with deadlines is key to avoiding this mistake.

Lastly, individuals sometimes forget to include their signature and the date on the certification section of the form. This certification is a declaration that the information provided is true and accurate. Without it, the form may not be accepted, leading to further delays.

By being mindful of these common pitfalls, individuals can ensure that their GA-4 New York form is filled out correctly, avoiding unnecessary complications and ensuring compliance with the Workers' Compensation Board requirements.

The GA-4 New York form, known as the Quarterly Unified Employer Assessment Municipal Self-Insurers Remittance Form, is essential for municipal self-insured employers in New York. It ensures that these employers report their payroll and pay the necessary assessments on a quarterly basis. Alongside the GA-4, there are several other forms and documents that are often used to provide additional information or fulfill reporting requirements. Below is a brief overview of four such documents.

• GA-4.1 - Payroll by FEIN Addendum: This addendum is required when a municipal self-insured employer has more than one employer approved to self-insure under the same W number. It details the payroll for each employer, ensuring accurate assessment calculations.
• NYS-45 - Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return: This form reports total remuneration paid to employees during the quarter. The data from this form should align with the payroll reported on the GA-4 to maintain consistency and accuracy.
• WCB Audit Request Form: This form may be issued by the Workers' Compensation Board when they require additional information or clarification regarding the assessments reported. It is essential for maintaining compliance and addressing any discrepancies.
• WCB Certification of Self-Insurance: This document certifies that a municipal employer is authorized to self-insure its workers' compensation liabilities. It is crucial for establishing the employer's status and compliance with state regulations.

Understanding these accompanying forms and documents is vital for municipal self-insured employers in New York. Proper completion and submission of these materials help ensure compliance with state regulations and avoid potential penalties. By staying informed and organized, employers can manage their self-insurance obligations effectively.

• NYS-45: Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return - Like the GA-4, this form requires employers to report payroll information on a quarterly basis. Both documents emphasize the importance of accurate reporting to ensure compliance with state regulations.
• WC-1: Workers' Compensation Self-Insurer Application - This form is similar in that it establishes the self-insured status of employers. Both the WC-1 and GA-4 require detailed employer information and are part of the self-insurance process.
• WC-3: Workers' Compensation Self-Insurer Annual Report - This document, like the GA-4, is essential for self-insured employers. Both forms require reporting of payroll and claims information, ensuring that the financial obligations of self-insured employers are met.
• DB-120: Disability Benefits Self-Insurer Application - Similar to the GA-4, this form is used by employers seeking self-insured status for disability benefits. Both require the submission of identifying information and payroll details.
• DB-300: Disability Benefits Self-Insurer Annual Report - This report mirrors the GA-4 in its requirement for annual payroll reporting and compliance verification for self-insured disability benefits.
• NYC-1: New York City Employer Registration Form - This form is comparable to the GA-4 as it collects essential employer information for compliance with city regulations. Both documents require the reporting of payroll information.
• Form 1099: Miscellaneous Income - While primarily a federal form, it shares similarities with the GA-4 in that both require reporting of payments made to individuals or entities. Accurate reporting is critical in both cases to avoid penalties.

Things You Should Do:

• Complete the GA-4 form accurately each quarter.
• Submit the form within thirty days after the quarter ends.
• Include all relevant payroll information for municipal employers covered under the W number.
• Ensure the WCB Identification Number is correct.
• Provide a full mailing address for correspondence.
• Make checks payable to the Chair, NYS Workers' Compensation Board.
• Include the applicable quarter and W Number on the check.
• Use the correct assessment rate as indicated on the form.
• Contact [email protected] for any questions or clarifications.

Things You Shouldn't Do:

• Do not submit the form late; it must be on time.
• Avoid omitting any employers covered under the W number.
• Do not use an incorrect or incomplete mailing address.
• Do not forget to sign and date the certification section.
• Do not ignore discrepancies between the GA-4 and NYS-45 payroll reports.
• Do not make checks payable to anyone other than the Chair.
• Do not provide inaccurate information, as this may lead to penalties.
• Do not assume that all payroll is subject to assessment without verification.
• Do not neglect to include the Payroll by FEIN Addendum if applicable.

• Misconception 1: The GA-4 form is optional for municipal self-insurers.

  This is incorrect. Every active municipal self-insured employer must complete the GA-4 form each quarter. Submitting this form is a requirement, not a choice.

• Misconception 2: Only large municipalities need to file the GA-4 form.

  In reality, all municipal self-insured employers, regardless of size, must submit the GA-4 form. This includes small towns and local districts.

• Misconception 3: The GA-4 form does not require supporting documentation.

  This is misleading. While the form itself is critical, it must be accompanied by supporting documentation, such as payroll records and any applicable addendums, to ensure accurate reporting.

• Misconception 4: The due date for submitting the GA-4 form is flexible.

  This is false. The form must be submitted within thirty days of the end of each quarter. Late submissions can lead to penalties and interest charges.

• Misconception 5: The assessment rate is the same every year.

  This is not true. The assessment rate can change annually based on decisions made by the Chair of the Workers' Compensation Board. It is essential to check for updates each year.

Filling out and using the GA-4 New York form is an essential process for municipal self-insurers. Here are some key takeaways to keep in mind:

• Quarterly Submission Required: Every active municipal self-insured employer must complete the GA-4 form each quarter and submit it within thirty days after the quarter ends.
• Accurate Reporting: Ensure that the WCB Identification Number (W Number), the full legal name of the municipal self-insured employer, and the Federal Employer Identification Number (FEIN) are correctly reported.
• Payroll Breakdown: Payroll must be categorized between school districts and other municipal employers, and the total payroll should align with the Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return (NYS-45).
• Payment Instructions: Payments should be made to the Chair of the NYS Workers' Compensation Board. Include the W Number and applicable quarter on the check to ensure proper application of payment.
• Certification of Accuracy: The undersigned must certify that all information provided is true and complete. Inaccurate reporting may lead to penalties or revocation of self-insured status.