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The document ceased to be valid according to the Order of the Ministry of Health and Social Development of the Russian Federation of 28.02.2011 No. 156n

IT IS REGISTERED

in Ministry of Justice

Russian Federation

On December 22, 2009 No. 15798

ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

of November 6, 2009 No. 871n

About approval of form of calculation for the assessed and paid insurance premiums for compulsory social insurance for case of temporary disability both in connection with motherhood and on compulsory social insurance from labor accidents and occupational diseases, and also on expenses on payment of insurance coverage

(as amended on on December 21, 2010)

According to Item 2 of part 9 of article 15 of the Federal Law of July 24, 2009 N 212-FZ "About insurance premiums in the Pension Fund of the Russian Federation, Social Insurance Fund of the Russian Federation, Federal Compulsory Health Insurance Fund and territorial funds of compulsory medical insurance" (The Russian Federation Code, 2009, N 30, the Art. 3738), part 2 of article 4.8 of the Federal Law of December 29, 2006 N 255-FZ "About compulsory social insurance on case of temporary disability and in connection with motherhood" (The Russian Federation Code, 2007, N 1, Art. 18; 2009, N 30 Art. 3739), the subitem 17 of Item 2 of Article 17 and Item 1 of article 24 of the Federal Law of July 24, 1998 N 125-FZ "About compulsory social insurance from labor accidents and occupational diseases" (The Russian Federation Code, 1998, N 31, Art. 3803; 2003, N 17, Art. 1554; N 52, of Art. 5037; 2008, N 30, Art. 3616; 2009, N 30, 3739) I order to the Art.:

1. Approve calculation form on the assessed and paid insurance premiums for compulsory social insurance for case of temporary disability both in connection with motherhood and on compulsory social insurance from labor accidents and occupational diseases, and also on expenses on payment of insurance coverage (form-4 of Social Insurance Fund of the Russian Federation) according to appendix.

2. Determine that this order becomes effective since January 1, 2010, since representation of calculation for the assessed and paid insurance premiums for compulsory social insurance for case of temporary disability both in connection with motherhood and on compulsory social insurance from labor accidents and occupational diseases, and also on expenses on payment of insurance coverage for the I quarter 2010.

 

Minister T. A. Golikova

Appendix

to the order of the Ministry of Health and Social Development of the Russian Federation of November 6, 2009 No. 871n

Calculation form on the assessed and paid insurance premiums for compulsory social insurance for case of temporary disability both in connection with motherhood and on compulsory social insurance from labor accidents and occupational diseases, and also on expenses on payment of insurance coverage (form-4 of Social Insurance Fund of the Russian Federation)

 
    Составляется и представляется ежекваратльно нарастающим Форма-4
ФСС РФ итогом не позднее 15 числа месяца, следующего за истекшим
кварталом, в территориальный орган (региональное отделение,
филиал регионального отделения) Фонда социального страхования
Российской Федерации (далее - Фонд) по месту регистрации
                   Заполняется в рублях и копейках
                                Расчет
по начисленным и уплаченным страховым взносам на обязательное
социальное страхование на случай временной нетрудоспособности и
в связи с материнством и по обязательному социальному страхованию
от несчастных случаев на производстве и профессиональных
заболеваний, а также по расходам на выплату
страхового обеспечения
_________________________________________________________________
(полное наименование организации (обособленного подразделения),
Ф И О индивидуального предпринимателя, физического лица)
                       +-----------------------------+
Регистрационный номер | | | | | | | | | | |
страхователя |--+--+--+--+--+--------------+
Код подчиненности | | | | | |
|--+--+--+--+--+--------------+
Дополнительный код* | | | | | | | | | | |
|--+--+--+--+--+--+--+--+--+--+-----+
ИНН | | | | | | | | | | | | |
|--+--+--+--+--+--+--+--+--+--------+
КПП | | | | | | | | | |
|--+--+--+--+--+--+--+--+--+-----------------+
ОГРН (ОГРНИП) | | | | | | | | | | | | | | | |
+--------------------------------------------+
Коды:
+---------------------------+
ОКОПФ | |
|---------------------------|
OKATO | |
|---------------------------|
ОКНО | |
|---------------------------|
ОКФС | |
|---------------------------|
ОКВЭД (осн.) I | |
+---------------------------+
+--+ +-------+
Отчетный период** | | Текущий расчетный период (год) | | | | |
+--+ +-------+
Дата представления расчета***____________________________________
______________________________________________________________________
(заполняется работником территориального органа Фонда)
____________________________________ ________________________________
(Фамилия И О) (подпись)
Место для штампа
_____________________________
*Для обособленных подразделений организации
**Oтчетный период заполняется зa квартал - 3. за полугодие - 6.,
за 9 месяцев - 9, за год- 0, при обращении за выделением средств - I
*** Указывается дата представления расчета лично или через
представителя, при отправке по почте - дата отправки почтового
отправления с описью вложения, при представлении в электронном виде -
дата отправки,зафиксированная о подтверждении специализированного
оператора связи
+-----------------------------+ +-----+
Регистрационный | | | | | | | | | | |стр.| | |
номер страхователя |--+--+--+--+--+--+--+--+--+--| +-----+
Дополнительный код | | | | | | | | | | |
обособленого подразделения +-----------------------------+
организации
                               Раздел I
расчет по начисленным, уплаченным страховым взносам на
обязательн

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