What is the BP-1 Workers’ Compensation Affidavit of Exemption?

It lets eligible homeowners of one- to four-family owner-occupied residences certify a workers’ compensation exemption when applying for a building permit.

Who can use the BP-1 form?

A homeowner listed as the general contractor may use it if they perform all the work, hire or pay no one, or meet the form’s homeowners insurance and under-40-hours conditions.

Do I need a notary for the BP-1 form?

No. The form has no notary block. Its text calls it an affidavit and says it serves as an exemption once notarized, but it does not state that notarization is required.

Whitestown, NY · Oneida County

No notary required

Workers’ Compensation Affidavit of Exemption

This affidavit is for homeowners of one- to four-family owner-occupied residences who seek a building permit and qualify for a workers’ compensation exemption.

What this form is

The form lets an eligible homeowner certify an exemption from specific proof of workers’ compensation coverage when applying for a building permit. It applies when the homeowner performs all the work, does not hire or pay anyone, or has homeowners insurance and pays workers less than 40 hours per week in total. It asks for the exemption basis, homeowner’s signature and date, telephone number, name, and property address.

Who needs it

A homeowner listed as the general contractor on a permit application for a one- to four-family owner-occupied residence may use this form if one of its exemption conditions applies.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This document is signed without a notary; it is an affidavit under penalty of perjury, and its text says it serves as an exemption once notarized, but does not provide a notary block.

How to submit this form

1
Download the BP-1 Form
Download the Workers’ Compensation Affidavit of Exemption for Whitestown.
2
Complete the Form
Check the exemption condition that applies and provide the homeowner and property details.
3
Sign and Date
Sign and date the form as the homeowner.
4
Submit to the City
Submit the form to the city department named on it; check the city website for current contact details.

Frequently asked questions

What is the BP-1 Workers’ Compensation Affidavit of Exemption?: It lets eligible homeowners of one- to four-family owner-occupied residences certify a workers’ compensation exemption when applying for a building permit.
Who can use the BP-1 form?: A homeowner listed as the general contractor may use it if they perform all the work, hire or pay no one, or meet the form’s homeowners insurance and under-40-hours conditions.
Do I need a notary for the BP-1 form?: No. The form has no notary block. Its text calls it an affidavit and says it serves as an exemption once notarized, but it does not state that notarization is required.
How do I submit the BP-1 form?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Workers’ Compensation Affidavit of Exemption doesn’t need a notary — but if you have another Whitestown form that does, a commissioned online notary can help.