Can this document be e-signed?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted; ensure signer intent, consent, attribution, and retrievable records.

When is a consumer disclosure required?

Consumer-facing records that replace paper require a disclosure and demonstrable access per 15 U.S.C. §7001(c); offer a paper option and confirm access capability.

Most pay statements do not require notarization; verify state law or specific settlement terms. If notarization is required, consider Remote Online Notarization with state rules.

How long should I retain signed statements?

Follow applicable federal rules: IRS records at least 3 years (IRC §6501(a)), HIPAA-covered records 6 years (45 CFR §164.530(j)), and longer if state law requires.

What happens if the payee’s name or TIN is wrong?

Incorrect TINs can trigger backup withholding (24%) and IRC §6721 penalties for incorrect returns; correct the record promptly and, if needed, reissue corrected forms.

How can I prove a signer signed electronically?

Maintain an audit trail with timestamp, IP address, authentication method, and a copy of the signed record to support attribution and legal enforceability.

Electronic Signature
Templates
Other
Statement of Compensation Paid

Statement of Compensation Paid

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

STATEMENT OF COMPENSATION PAID

STATE OF MAINE

WORKERS' COMPENSATION BOARD

27 STATE HOUSE STATION, AUGUSTA, MAINE 04333-0027

1. INSURER FILE NUMBER:

6. SOCIAL SECURITY NUMBER (last 4 digits): XXX-XX-

2. EMPLOYER NAME:

7. WCB FILE NUMBER:

3. EMPLOYER MAILING ADDRESS AND PHONE NUMBER:

8. EMPLOYEE LAST NAME:

4. INSURER NAME:

9. FIRST NAME:

5. INSURER MAILING ADDRESS:

10. M.I.:

11. ADDRESS-NUMBER AND STREET:

12. CITY:

13. STATE:

14. ZIP:

15. HOME PHONE:

16. DATE OF INJURY:

17. DESCRIPTION OF INJURY:

18. REASON FOR REPORT:

INTERIM REPORT (ONGOING PAYMENTS OF ANY KIND) FINAL REPORT (NO FURTHER PAYMENTS ANTICIPATED)

PAYMENT SUMMARY

19. LIST CUMULATIVE TOTALS (DO NOT INCLUDE ANY PENALTY AMOUNTS):

MEDICAL TREATMENT $

DEATH BENEFIT/FUNERAL EXPENSE (NOT TO EXCEED $7,000.00) $

WEEKLY COMPENSATION $

TPD EXPENSE (EMPLOYEE RELATED) $

PERMANENT IMPAIRMENT (PRE 1993 ONLY) $

LEGAL EXPENSE (EMPLOYEE RELATED) $

EMPLOYMENT REHABILITATION $

INTEREST AND OTHER PAYMENTS $

LUMP SUM SETTLEMENT $

TOTAL AMOUNT PAID $

(DO NOT REDUCE THESE TOTALS BY THE AMOUNT OF ANY RECOVERIES, INCLUDING DEDUCTIBLES)

ASSISTANCE IS AVAILABLE AT THE MAINE WORKERS' COMPENSATION BOARD'S REGIONAL OFFICES

AUGUSTA

442 CIVIC CTR DR, STE 225

156 STATE HOUSE STATION

AUGUSTA, ME 04333-0156

(207) 287-2308

1-800-400-6854

BANGOR

106 HOGAN RD

BANGOR, ME

04401-5638

(207) 941-4550

1-800-400-6856

CARIBOU

ONE VAUGHN PL

43 HATCH DR, STE 110

CARIBOU, ME 04736

(207) 498-6428

1-800-400-6855

LEWISTON

36 MOLLISON WAY

LEWISTON, ME

04240-7777

(207) 753-7700

1-800-400-6857

PORTLAND

1037 FOREST AVE, STE 11

PORTLAND, ME

04103

(207) 822-0840

1-800-400-6858

20. PREPARER NAME (TYPE OR PRINT):

E-MAIL ADDRESS:

21. TELEPHONE NUMBER: ( )

TOLL-FREE NUMBER: ( )

22. DATE MAILED:

The State of Maine provides equal opportunity in employment and programs. Auxiliary aids and services are available to individuals with disabilities upon request. For assistance with this form, contact the ADA Coordinator at the Maine Workers' Compensation Board. Telephone: 1-888-801-9087 or TTY Maine Relay 711.

WCB-11 (eff. 1/1/13, rev. 1/28/19)

What a Statement of Compensation Paid Is and when it’s used

A Statement of Compensation Paid documents wages, bonuses, reimbursements, and deductions for a defined pay period or event. Employers, payroll providers, and independent contractors use it to summarize gross pay, taxes withheld, net pay, pay period dates, and reason for payment. The document serves payroll reconciliation, internal audit, and recipient verification purposes and can accompany tax reporting, year-end statements, or one-time settlements.

Why a clear compensation statement matters

Clear statements reduce payroll disputes, ease tax reporting, and provide an auditable record of amounts paid and withheld for both payers and payees.

Who prepares and receives a Statement of Compensation Paid

Recipients use the statement to confirm amounts, support tax reporting, and maintain financial records; accurate preparation reduces follow-up and audit exposure.

Employers and payroll teams providing regular pay summaries or one-time settlement statements to employees or contractors.
Accounting and finance personnel using statements to reconcile payroll liabilities and prepare tax filings.
Contractors, vendors, and recipients who need a formal record for tax, bank, or compliance purposes.

Step-by-step: prepare and deliver the statement

Follow a consistent sequence to prepare, verify, and deliver a compliant Statement of Compensation Paid.

01

Gather payroll data: Collect timecards, benefit reports, and tax withholding details for the period.
02

Compute amounts: Calculate gross pay, pre-tax contributions, taxes, and net pay precisely.
03

Populate template: Enter payer/payee data, pay period, itemized deductions, and employer identification numbers.
04

Verify and sign: Confirm accuracy, obtain authorized signature, and save audit trail.

How delivery and recordkeeping typically flow

Standard workflows move from data collection to statement issuance, recipient acknowledgement, and archival.

Upload source files: Import payroll exports or enter data manually into the template.
Insert fields: Add signature, date, and conditional fields as needed for electronic execution.
Send to recipient: Deliver via secure email, portal, or eSignature link with audit trail.
Archive record: Store signed copies for required retention periods and compliance.

Digital workflow settings to configure

Key configuration choices reduce friction and preserve evidentiary value for e-signed compensation statements.

Field	Configuration
Authentication level	Email + access code or SMS two-factor recommended for sensitive payroll records.
Signer order	Set serial or parallel signing depending on approvals required.
Notifications	Enable reminders and completion receipts to reduce unsigned items.
Audit retention	Capture IP, timestamps, and change history for forensic use.

Technology and integrations to support electronic statements

Integrations with systems such as payroll or ERP reduce duplicate data entry and help ensure statements match reported tax data.

Core integrations: Payroll systems, HRIS, and accounting platforms.
Document formats: PDF, DOCX, and Excel import/export supported.
Security features: TLS in transit and AES-256 at rest.

Essential elements to include in a professional statement

A complete Statement of Compensation Paid combines identifications, pay calculations, itemized deductions, and attestations to serve payroll reconciliation and compliance.

Payer Details

Full legal name, employer identification number (EIN), and contact details so the recipient and tax authorities can identify the payer and verify responsibility for reported amounts.

Payee Details

Full legal name, tax identification number or TIN, and address to ensure the recipient matches tax records and to prevent backup withholding triggers.

Pay Period

Explicit start and end dates for wages or payment events; essential for tax period allocation and for matching payroll system exports.

Earnings Breakdown

Itemize regular wages, overtime, bonuses, reimbursements, and other taxable or non-taxable amounts so each component is auditable and correctly classified.

Deductions and Taxes

Itemize federal, state, local taxes withheld, benefit contributions, and wage garnishments for clarity in reconciliation and employee queries.

Authorized Attestation

Authorized signer name, title, signature, and date to provide legal attribution and evidence of review, plus any electronic signature certificate or audit-trail reference.

Security and compliance controls to preserve integrity

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Access control: Role-based permissions and SSO support

Audit trail: IP address, timestamp, and action log

HIPAA BAA: Available when handling PHI

ESIGN/UETA: Supports legal e-signature frameworks

Certifications: SOC 2 Type II, ISO 27001 compliance

Common preparation pitfalls to avoid

Mismatched names between payee and TIN records causing backup withholding and IRS mismatches.
Omitting itemized deductions, making reconciliation and audits more time-consuming.
Using ambiguous descriptions like 'other' without explanation, which complicates classification.
Failing to capture an auditable signature and retention record for the executed statement.

Consequences of incorrect or missing statements

Tax Penalties: IRC §6721 fines for incorrect information returns

Backup Withholding: 24% withholding for incorrect or missing TIN

I-9 Violation: Paperwork fines under 8 CFR §274a.2

Employment Disputes: Claims over unpaid wages or misreported deductions

Audit Exposure: Increased forensic review from inconsistent records

Data Breach Risk: PII exposure if not secured properly

Timing and deadlines often associated with compensation statements

While internal pay statements follow payroll cycles, some related filings have statutory deadlines that affect reporting and distribution.

Pay Frequency:

Issue statements according to payroll schedule (weekly, biweekly, monthly).

1099-NEC Deadline:

Form 1099-NEC to recipient and IRS by Jan 31

W-2 Deadline:

Provide W-2 to employees by Jan 31

Tax Return:

Individual returns due April 15 (Form 1040)

Record Retention:

Keep payroll records per retention rules in case of audit

Real-world examples of electronic payroll and settlement statements

Organizations of various sizes use digital statements to speed reconciliation and provide auditable records for recipients.

Tim Martin, Founder — Martin Properties

Martin Properties standardized online statements to speed approvals and recordkeeping.

Saved time on mobile and offline signing.
"I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently."

John Butler, Founder — Fertility Centers of Illinois

A healthcare practice needed secure, auditable compensation records.

Added HIPAA controls and secure signers.
"The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company."

Pricing and basic capabilities for eSignature providers

Compare starting pricing and select capabilities relevant to signing and distributing Statement of Compensation Paid documents.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about electronic statements and signatures

Answers to common questions about e-signing, enforceability, retention, and distribution of compensation statements.

Need help? Contact support

Can this document be e-signed?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted; ensure signer intent, consent, attribution, and retrievable records.
When is a consumer disclosure required?
Consumer-facing records that replace paper require a disclosure and demonstrable access per 15 U.S.C. §7001(c); offer a paper option and confirm access capability.
Do I need a notary?
Most pay statements do not require notarization; verify state law or specific settlement terms. If notarization is required, consider Remote Online Notarization with state rules.
How long should I retain signed statements?
Follow applicable federal rules: IRS records at least 3 years (IRC §6501(a)), HIPAA-covered records 6 years (45 CFR §164.530(j)), and longer if state law requires.
What happens if the payee’s name or TIN is wrong?
Incorrect TINs can trigger backup withholding (24%) and IRC §6721 penalties for incorrect returns; correct the record promptly and, if needed, reissue corrected forms.
How can I prove a signer signed electronically?
Maintain an audit trail with timestamp, IP address, authentication method, and a copy of the signed record to support attribution and legal enforceability.

Explore Templates

Conditional Waiver and Release on Final Payment Unconditional Waiver and Release on Final Payment California Mechanics Lien Law FAQs Deed of Dedication Form 10 Proof of Restricted Account Waiver of Liability

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now