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Preview - Ohio Ua 3 Form

Professional Employer Organization

Client Relationship Notification

Instructions

Use this form to notify BWC of a new client, change of relationship with a current client or termination of a client.

Mail this form to BWC, PEO Unit, 22nd Floor, 30 W. Spring St., Columbus, OH 43215-2256, or send a fax to 614-719-5925.

BWC must receive new contract notification within 30 days of the effective date of the contract. BWC must receive contract termination notifications within 14 days of the effective date of the termination.

Notice: Pursuant to Ohio Administrative Code 4123-17-15.1(B), if BWC is not notified within the required time frame, BWC will recognize the date the UA-3 is received as the effective date.

Professional employer organization (PEO) information

Company name

Policy number

 

 

Contact person name

Telephone number

 

 

 

 

PEO lease information

Check only one

Change existing policy number reporting client

Effective date of lease, termination or change in

New lease

payroll/claims

Ohio

 

Lease termination

Change to portion of client’s employees assumed by PEO

 

 

 

 

(No splitting of employees within a manual classification)

 

Client company information

Client company name

Client policy number

 

 

 

 

 

DBA

Federal ID number

 

 

 

 

 

Mailing address (P.O. Box if applicable)

Client phone number

 

 

 

 

 

City

State

Nine-digit ZIP code

 

 

 

 

 

 

 

 

 

 

 

Employee reporting (payroll and claims)

 

 

List class codes reportable by PEO

 

List class codes reportable by client

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All under the PEO policy

 

 

PEO

 

 

Client

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All under the client policy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A portion under the PEO policy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Partial wages reported to BWC under the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

client policy must be reported under the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEIN of the client employer)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signatures are required by both parties

Title

Date

Print client signatory

Client signature

Print PEO signatory

PEO signature

Note: Signing this form is an acknowledgement that all the information listed on this form is complete and true to the best of your knowledge. Omission of any of the items required or intentional misrepresentation of any of the above information on this form may lead to registration revocation as outlined in Ohio Revised Code Section 4125.

BWC-8003 (May 15, 2014)

UA-3

Document Properties

Fact Name Details
Purpose This form notifies the BWC of a new client, changes in relationship, or termination of a client.
Submission Method Mail to BWC, PEO Unit, 30 W. Spring St., Columbus, OH 43215-2256 or fax to 614-719-5925.
New Contract Notification Deadline BWC must receive notifications within 30 days of the contract's effective date.
Contract Termination Notification Deadline Notifications must be received within 14 days of the termination's effective date.
Effective Date Recognition If not notified in time, BWC recognizes the receipt date of the UA-3 as the effective date.
Governing Law Ohio Administrative Code 4123-17-15.1(B) governs the notification process.
PEO Information Required Includes company name, policy number, contact person, and telephone number.
Client Company Information Required Includes client company name, policy number, DBA, federal ID number, and mailing address.
Signatures Both parties must sign the form to acknowledge the truthfulness of the information provided.

Documents used along the form

The Ohio UA-3 form is an essential document for notifying the Bureau of Workers' Compensation (BWC) about changes in the relationship between a Professional Employer Organization (PEO) and its clients. Along with the UA-3, several other forms and documents are often used in this context. Here’s a brief overview of those documents.

  • UA-3A Form: This form is used to provide additional information about the client relationship, especially when there are multiple clients under one PEO. It helps clarify the reporting responsibilities for each client.
  • Georgia Quitclaim Deed: This legal document is essential for transferring property ownership in Georgia without title guarantees, often utilized among family members, and can be accessed at smarttemplates.net.
  • PEO Client Agreement: This contract outlines the terms and conditions between the PEO and the client. It details the services provided and the responsibilities of both parties.
  • Payroll Reports: These documents provide detailed information about employee wages and classifications. They are essential for accurate reporting to the BWC and for determining workers' compensation premiums.
  • Claims Reports: This document includes information on any workers' compensation claims filed by employees. It helps track claims and manage the overall risk for the PEO and its clients.
  • Client Policy Number Verification: This form is used to confirm the policy number associated with the client. It ensures that all parties are referencing the correct insurance coverage.
  • Wage Reports: These reports detail the wages paid to employees under the PEO's policy. They are necessary for compliance with BWC regulations and for determining premium calculations.
  • Termination Notice: When ending a client relationship, this document formally notifies the BWC and outlines the effective date of termination. It must be submitted within the specified time frame to avoid issues.

Each of these documents plays a vital role in ensuring compliance and maintaining clear communication between the PEO, its clients, and the BWC. Properly managing these forms helps avoid potential complications and ensures a smooth working relationship.

Guidelines on Filling in Ohio Ua 3

Completing the Ohio UA-3 form is a straightforward process that requires accurate information about your Professional Employer Organization (PEO) and client relationship. Once the form is filled out correctly, it must be submitted to the Bureau of Workers' Compensation (BWC) within the specified time frames to ensure compliance.

  1. Begin by entering the PEO information at the top of the form. Include the company name, policy number, contact person’s name, and telephone number.
  2. Next, check only one box to indicate the type of PEO lease information you are reporting: a change to an existing policy number, the effective date of a lease, termination of a lease, or a change regarding the portion of client employees assumed by the PEO.
  3. Fill in the client company information section. This includes the client company name, client policy number, DBA (Doing Business As) name, federal ID number, mailing address (including P.O. Box if applicable), client phone number, city, state, and nine-digit ZIP code.
  4. List the employee reporting details. Specify the class codes that are reportable by both the PEO and the client. Indicate whether all wages are reported under the PEO policy, the client policy, or a portion under the PEO policy.
  5. Obtain the necessary signatures. Both the client and PEO signatories must print their names, titles, and dates, and provide their signatures on the form.

After completing the form, review it carefully to ensure all information is accurate and complete. Submit the UA-3 form to the BWC by mailing it to the specified address or by faxing it to the provided number. Adhering to the submission deadlines is crucial to avoid any issues with your PEO-client relationship.

Common mistakes

Filling out the Ohio UA-3 form can seem straightforward, but many people make common mistakes that can lead to delays or complications. One frequent error is not submitting the form within the required time frame. The Bureau of Workers' Compensation (BWC) must receive notifications of new contracts within 30 days and terminations within 14 days. If the form is late, BWC will use the date they receive it as the effective date, which can create confusion and potential issues.

Another mistake occurs when individuals forget to provide complete information. Each section of the form is essential, from the Professional Employer Organization (PEO) details to the client company information. Omitting any required items can lead to the form being rejected or processed incorrectly. It’s crucial to double-check that all fields are filled out accurately and completely.

Additionally, people often misinterpret the section regarding employee reporting. The form requires clarity on how payroll and claims are reported under different policies. Misunderstanding these requirements can result in incorrect classifications or reporting, which can have financial implications. Always ensure that the class codes are correctly listed and that there is no splitting of employees within a manual classification.

Signatures are another area where mistakes frequently happen. Both the client and the PEO must sign the form. Failing to obtain the necessary signatures can delay processing. It’s important to confirm that the titles and printed names are included, as missing this information can lead to complications.

Lastly, some individuals may overlook the significance of the acknowledgment statement at the bottom of the form. Signing indicates that all provided information is accurate and complete. Misrepresentation or omissions can lead to serious consequences, including the revocation of registration. Always review the form thoroughly before signing to ensure that everything is in order.

FAQ

  1. What is the purpose of the Ohio UA-3 form?

    The Ohio UA-3 form is designed to notify the Bureau of Workers' Compensation (BWC) of various changes in the relationship between a Professional Employer Organization (PEO) and its clients. This includes notifying BWC of a new client, changes in the relationship with an existing client, or the termination of a client relationship.

  2. How should the Ohio UA-3 form be submitted?

    The completed form can be mailed to the BWC at the following address: PEO Unit, 22nd Floor, 30 W. Spring St., Columbus, OH 43215-2256. Alternatively, it can be sent via fax to 614-719-5925.

  3. What are the deadlines for submitting the UA-3 form?

    It is crucial to adhere to specific deadlines when submitting the UA-3 form. For new contract notifications, BWC must receive the form within 30 days of the effective date of the contract. For contract termination notifications, submission must occur within 14 days of the effective date of termination.

  4. What happens if the UA-3 form is not submitted on time?

    If the BWC does not receive the UA-3 form within the required time frame, they will recognize the date the form is received as the effective date of the change. This could lead to complications in the management of workers' compensation claims and obligations.

  5. What information is required on the UA-3 form?

    The UA-3 form requires various pieces of information, including:

    • PEO information: Company name, policy number, contact person name, and telephone number.
    • PEO lease information: Effective date of lease, termination, or change, and details regarding the payroll and claims.
    • Client company information: Client company name, policy number, DBA, federal ID number, mailing address, and phone number.
    • Employee reporting: Class codes reportable by both the PEO and the client.
  6. What does the signature section of the UA-3 form entail?

    Both parties involved—the PEO and the client—must provide signatures on the UA-3 form. This signature serves as an acknowledgment that all the information provided is accurate and complete to the best of their knowledge. Any omission or misrepresentation may lead to revocation of registration.

  7. What are the consequences of providing false information on the UA-3 form?

    Providing false or incomplete information on the UA-3 form can have serious consequences. It may lead to registration revocation as outlined in Ohio Revised Code Section 4125. This emphasizes the importance of accuracy and honesty when completing the form.

  8. Where can I find additional assistance regarding the UA-3 form?

    If you need further assistance, you may contact the BWC directly. They can provide guidance on completing the form and answer any questions you may have regarding your specific situation.