R-50 Worker's Compliance Agreement Verification Form (State/Metro)

This form must be submitted annually to USA Ministries by April 15.

All individuals involved in CEF ministry must sign the Worker’s Compliance Agreement (see R-7) annually. (See USA Operations and Policy Manual, Section 400 and 200.1.1.)

Please fill in the blank for the year you are reporting about. ( It will always be the year previous to the current year. EX: in 2024 you will report for 2023) *

A signed Worker's Compliance Agreement form from all those involved in CEF ministry has been received. CHECK ONE: *

Yes

If "No," describe below your plan to bring your state into compliance: *

Name of State/Metro Affliate *

(NOTE: On electronic forms, your typed signature carries the same weight as your written signature.)

State/Metro Board Chairman Signature *

Date Signed * +

Board chairman email address *