Application for the allocation of funds for payment of insurance coverage. Sample

What else do you need to provide?

In addition to writing the application, the employer's representative must create a package of several more papers. These include:

calculation according to form 4-FSS;
copies of documents serving as evidence of the validity and reliability of expenses for compulsory insurance payment.

The latter include pregnancy certificates, birth certificates, certificates of incapacity for work issued in clinics and antenatal clinics, as well as payment forms drawn up in accounting departments with the amounts of payments for these benefits indicated in them and other papers. All of them must be current and properly certified.

You also need to attach a certificate confirming that there is no debt to the fund or, if there is a debt, data on its amount; in addition, you must have on hand a list of social payments made during the compensation period.

Application form for payment of insurance coverage

20.03.2018

Calculation of accrued and paid insurance contributions for compulsory social insurance in case of temporary disability and in connection with maternity and for compulsory social insurance against industrial accidents and occupational diseases, as well as the costs of paying insurance coverage

Application for allocation of funds for payment of insurance coverage

In order to write an application for the allocation of funds for the payment of insurance coverage, it is necessary that the enterprise has a certain basis, which is the excess of the actual volume of insurance payments over the amount of accrual. Thus, the Fund reimburses the difference between the accrued and actually paid amounts.

Documents for the allocation of funds from the Social Insurance Fund

the amount of the insurer's debt (FSS) for insurance premiums at the beginning and end of the reporting (calculation) period;
the amount of insurance premiums accrued for payment, including
for the last three months;
the amount of additional accrued insurance premiums;
the amount of expenses not accepted for offset;
the amount of funds received from the territorial bodies of the Social Insurance Fund to reimburse expenses incurred;
the amount of returned (credited) overpaid (collected) insurance premiums;
the amount of funds spent for the purposes of compulsory social insurance, including over the last three months;
the amount of insurance premiums paid, including for the last three months;
the amount of the insured's debt written off;

Application for allocation of funds for payment of insurance coverage (form and sample)

The size of the payment is determined according to the degree of disability and is based on the maximum amount, which is regulated by the federal legislation of the Russian Federation.

A one-time payment is established for each citizen. Payment is made no later than a month from the day on which such payments are scheduled.

Payment transactions continue throughout the entire time period when the citizen’s ability to work is lost.

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Application for FSS reimbursement

on sick leave (starting from the fourth day of illness);
for pregnancy and childbirth;
women who registered with the antenatal clinic before 12 weeks of pregnancy;
for the birth of a child;
caring for a child up to 1.5 years old;
to pay a pension to a disabled person who received an industrial injury;
for burial.

Application for compensation for sick leave to the Social Insurance Fund, sample filling

With the exception of the application and calculation, both originals and copies of the specified documents can be submitted. As part of the listed documentation, the application is the key document. Its page form involves detailing the amounts of benefits and a mandatory indication of the amount of compensation. It is used more often by policyholders as a standard sample.

Application for payment of insurance coverage sample

- so as not to lose. It is submitted to the FSS department together with 4-FSS when paying hospital benefits, maternity benefits, child care benefits, etc. If the amount of these benefits exceeds the amount of FSS insurance premiums. Download for free Application for the allocation of funds for payment of insurance coverage sample with formulas 29 kb.

Reimbursement of expenses to the Social Insurance Fund in 2021 (sample attached)

For example, if a company transferred benefits to its pregnant employee, then it needs to provide the Social Insurance Fund with a copy of the girl’s certificate of incapacity for work to reimburse expenses.

It is not necessary to send the original to the government agency: a photocopy certified in accordance with the requirements of the Government of the Russian Federation is sufficient.

Make sure that the document contains the name of the clinic (hospital), the name of the employing organization, the date of issue of the sick leave, and personal information of the pregnant woman.

List of documents to the Social Insurance Fund for reimbursement of expenses

A copy of a certificate from the social security authorities at the place of residence of the other parent about his non-receipt of benefits for child care under 1.5 years old and a copy of the work record book (or a statement that I am asking to assign benefits without a copy of the work record book, since my husband (wife) ), full name, does not have a work book).

Documents required for each application.

Payment application form

Certificate form No. 31 or a copy certified by the traffic police
Certificate Form No. 12 or a copy certified by the traffic police
Certificate of a traffic accident issued by the State Traffic Safety Inspectorate - form No. 154 (or No. 748, issued before 01.02.
2012)
A copy of the protocol on an administrative offense, certified by the traffic police
A copy of the resolution in the case of an administrative violation, certified by the traffic police
A copy of the decision to refuse to initiate a case of an administrative violation, certified by the State Traffic Safety Inspectorate - replaces copies of the protocol and resolution on the administrative violation
A copy of the decision - a receipt for the imposition of an administrative fine, certified by the State Traffic Safety Inspectorate
Verdict/Court decision/Resolution to refuse to initiate criminal proceedings - original or a copy certified by the court

Application for payment of insurance coverage to the Social Insurance Fund

The amount of payments depends on the average earnings of the insured person, which is calculated based on his total income for a certain period of time. To calculate the amount of insurance payment, it is necessary to multiply the average income of a citizen by the degree of loss of ability to work.

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Application for the allocation of funds for the payment of insurance coverage Enterprises and organizations registered in Russia have the right to reimbursement of funds paid to employees as insurance coverage. To do this, they need to submit a number of documents to the Social Insurance Fund, including a corresponding application.

Filling out an application to the FSS

The exact list of papers depends on the specific situation (type of benefit, payment deadline, etc.). It is recommended to check the list with a fund employee. In some cases, an application is also submitted with a request for the assignment of benefits (for example, in relation to a monthly child care allowance).

Social Insurance Fund of the Russian Federation on the allocation of the necessary funds for the payment of insurance coverage. Sample application for the allocation of funds for payment of insurance coverage.

Conditions, amounts and procedure for payment of insurance coverage. The unified application form for reimbursement of expenses is not approved by the fund.

Fund with a statement of financial support for preventive measures and.

Application for payment of insurance coverage sample

from LLC "Alpha" INN 7715123456, checkpoint 771501001 Address of the organization's location: 127490, Moscow, Northern Boulevard, 12 Registration number: 7729011234 Subordination code: 77291 tel. (499) 123-45-67, email address. mail: Contact person - chief accountant Nikolay Pavlovich Eremeev

Application form for payment of insurance coverage Link to main publication

How long to wait for a refund

After the collected package of documents is transferred to the Social Insurance Fund, the policyholder can wait to receive funds within no more than ten days from the date of transfer of the papers.

However, it should be remembered that in some cases, the insurer may initiate a desk or on-site audit in order to analyze the fairness and reliability of the costs of paying benefits.

This is due to the fact that from the beginning of 2021, the responsibility for administering and monitoring the payment of insurance premiums has transferred to the tax authorities. During the inspection, inspectors may request additional information and papers from the organization.

In such cases, the duration and even the very possibility of paying insurance coverage depends solely on the results of the verification event.

In this case, the organization must receive the insurer’s decision no later than three days after its adoption.

If the company does not agree with the results of the inspection, it can appeal them in court (of course, it is better to do this only when there is one hundred percent confidence in its own rightness).

Drawing up an application

The application for the allocation of funds for the payment of insurance coverage has a unified form , which is recommended for use. You must be extremely careful when drawing up your application, trying to avoid any mistakes or inaccuracies.

If some error nevertheless crept into the document, there is no need to try to correct it, it is better to issue a new form. And even more so, it is unacceptable to include unreliable or deliberately false information in the application - if such facts are discovered, the organization and its management may face serious punishment.

What documents are attached?

The main document on the basis of which the company is reimbursed for the funds spent is the Application with two Appendices.

In addition, copies of certificates and other documents that serve to justify insurance payments are submitted to the local FSS authority. Their list is fixed by Orders of the Ministry of Health and Social Development No. 951n and No. 585n.

Which certificates must be attached to the application depends on the situation in which insurance payments are made to the employee.

If we are talking about the birth of a child or the provision of childcare benefits, a copy of the birth certificate is attached to the application.

In case of pregnancy, the woman submits a certificate from the antenatal clinic about registration.

In case of temporary incapacity for work, the employee submits a sick leave certificate to the employer. He, in turn, attaches a copy of it to the application for payment of insurance funds.

All documents are carefully checked by the insurer, so false information must not be included in them. Otherwise, reimbursement will be denied.

A copy of the decision made by the FSS is sent to the tax authority, where the documents will also be carefully checked. If they consider that they are not enough to make payments, the employer must provide additional data.

Thus, the employer must present the following documents to the insurer:

statement;
certificate-calculation (Appendix No. 1);
breakdown of expenses (Appendix No. 2);
copies of documents confirming that payments were made lawfully.

If they are filled out correctly and the information in them is true, the organization will be allocated funds to pay insurance coverage.

Filling out the document

At the beginning of the document we write the addressee: the name of the institution to which the application is being submitted, the position of the head and his last name, first name and patronymic.
Then detailed information about the insured is entered: the name of the enterprise, its constituent details: registration number in the Social Insurance Fund, subordination code, tax identification number, checkpoint, legal address.
Next, enter the amount that is required for compensation (in numbers and words), as well as the specific reason.
After this, the form includes information about the bank details of the recipient company.
Finally, the application is signed by the responsible employees: the director and the chief accountant.

It is not necessary to certify the application using a seal or stamp - from 2021 this must be done only if the standard for the use of stamped products is enshrined in the internal regulations of the company.

The application is written in two copies, one of which is submitted to the social insurance fund, the second, after being endorsed by a representative of the Social Insurance Fund, remains in the hands of the employees of the applicant organization.

statements

Each regional branch of the FSS has its own application form posted on the website. They may differ slightly from each other, but in any case they should contain the following points:

Recipient (head of the Social Insurance Fund department);
Title of the application;
Policyholder;
Registration number assigned to the enterprise or entrepreneur in the Social Insurance Fund;
The amount that the company needs;
Subordination code;
TIN;
Address where the organization is located or the individual entrepreneur resides;
Bank details of the organization;
Signature and full name manager;
Signature and full name chief accountant.

you can follow the link.

The application can be completed by hand in black ink or typed on a computer.

How to submit an application

There are several ways to submit your application:

The fastest, most accessible and easiest way today is electronic means of communication. True, there are some peculiarities here:
secondly, sending a letter in this way does not guarantee that it will not accidentally get lost in the recipient's mailbox.
Handover personally into the hands of an FSS employee.
Sending an application through a representative.
via regular Russian Post by registered mail with acknowledgment of delivery.

All these methods guarantee that the letter reaches the addressee and will be read and processed by him.