New York State Workers' Compensation Board Forms

This document is a sworn statement for claiming compensation for a person's death. It is specific to New York and is in Spanish.

This form is used by a claimant in New York to declare a personal injury or other non-work related injury.

This form is used for the claimant to give authorization to disclose their Workers' Compensation Board records in New York.

This type of document is a RFA-1WS Form used for requesting assistance for an injured worker in New York.

This form is used for reporting a loss of income in New York. It collects professional data for documentation purposes. (Spanish)

This Form is used for registering participation in rescue, recovery, and/or cleaning operations at the World Trade Center. It requires a sworn statement under Section 162 of the Workers' Compensation Law in New York.

Este formulario se utiliza para presentar un reclamo de compensación en caso de fallecimiento de un trabajador en Nueva York.

This form is used for employers in New York to report work-related injuries or illnesses. It is specifically for the Russian language.

This Form is used for obtaining limited release of health information under HIPAA in New York for Russian-speaking individuals.

This form is used for requesting a redetermination of extreme hardship in New York for Russian-speaking individuals.

This Form is used for claimants in New York who speak Russian to record their independent job search efforts.

This document is used by claimants in New York, who speak Russian, to provide a statement regarding no fault or personal injury.

This document is used for filing an affidavit to claim death benefits in New York, specifically for Russian speakers.

This form is used for authorizing the disclosure of workers' compensation records for claimants in New York who speak Russian.

This form is used for filing a claim for compensation in a death case in New York. It is specifically for cases where the language of preference is Russian.

This form is used for reporting the loss of wage earning capacity in New York. It is specifically tailored for Russian-speaking individuals.

This document is a request form for injured workers in New York who speak Russian. It is used to request for assistance.

This document is used for employers in New York to report work-related injuries or illnesses and is available in Polish language.

This form is used for registering participation in the World Trade Center rescue, recovery, and/or clean-up operations in New York. This particular version of the form is in Russian.

This form is used for Waiver Agreements related to Section 32 of the Workers' Compensation Law in New York. The form is available in Polish language.

This type of document is a Section 32 Waiver Agreement specifically for Polish-speaking claimants in New York. It is used to release the claimant from further liability and settle a claim.

This document is used for applying for death benefits in New York for Polish-speaking individuals.

This document is used for Polish-speaking claimants in New York to record their independent job search efforts.

This form is used for requesting a redetermination of extreme hardship based on the specific circumstances of individuals who are Polish and residing in New York.

This form is used for Polish-speaking individuals in New York to submit a statement regarding no fault or personal injury claims.

This Form is used for claiming compensation in a death case in New York. It is specifically for Polish speakers.

This form is used to request assistance from the New York Workers' Compensation Board for injured workers who speak Polish.

This document is used for authorizing the disclosure of workers' compensation records in New York. It specifically applies to claimants who speak Polish.

This form is used for collecting vocational data in cases of loss of wage earning capacity in New York. It is available in Polish language.

This form is used for registering participation in World Trade Center rescue, recovery, and/or clean-up operations in New York for Polish individuals.

This Form is used for reporting work-related injuries or illnesses by employers in New York. It is specifically tailored for Chinese-speaking individuals.

This form is used for injured workers in New York who speak Chinese to request assistance.

This form is used for registration of participation in World Trade Center rescue, recovery, and/or clean-up operations in New York for Chinese individuals or organizations.

This form is used for employers in New York to report work-related injuries and illnesses, specifically for Italian-speaking individuals.

This document is a settlement agreement used for indemnity-only settlements under Section 32 of the Workers' Compensation Law in New York. It is specifically tailored for Italian speakers.

This form is used for filing an affidavit to claim death benefits in New York. It is specifically designed for individuals who are of Italian descent.

This Form is used for requesting a redetermination of extreme hardship for Italian immigrants in New York.