Dwc 11 2026

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The document is a notice from the Rhode Island Department of Labor and Training regarding the designation of an individual as an independent contractor under RIGL §28-29-17.1. It outlines that by signing the form, the individual acknowledges they are not entitled to workers' compensation benefits for injuries sustained while working as an independent contractor. The document also provides warnings about coercion, tax implications, and instructions for withdrawing the designation.

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Click ‘Get Form’ to open the dwc 11 in the editor.
Begin by filling in your name and Social Security Number in the designated fields. Ensure accuracy as this information is crucial for identification.
Next, enter your Business Name, FEIN, and Business License Number. This section confirms your business identity as an independent contractor.
Provide your address and date of birth. This information helps establish your residency and age verification.
In the hiring entity section, input the name, Social Security Number, FEIN, and address of the entity you are contracting with. This identifies who you are working for.
Finally, sign and date the form at the bottom to confirm your status as an independent contractor. Remember that signing indicates you understand you are not eligible for Workers’ Compensation benefits.

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