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152222

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This form is used for registering participation in World Trade Center rescue, recovery, and/or cleanup operations in New York. It requires a sworn statement, and it is available in Urdu language.

This document is used for authorizing the release of medical information under the Health Insurance Portability and Accountability Act (HIPAA) in New York.

This document is used for registering participation in World Trade Center rescue, recovery, and/or cleanup operations in New York. It requires a sworn statement according to WCL 162. This version of the document is in Bengali.

This document is for World Trade Center volunteers who need to submit a claim for compensation in New York. It is available in French.

This Form is used to inform individuals in New York that they may be responsible for medical costs if their compensation claim is disallowed or if an agreement pursuant to WCL 32 is approved. The form is available in French.

This Form is used for filing an affidavit to claim death benefits in New York. This form is available in the French language.

This form is used to notify individuals in New York of their right to choose a healthcare provider authorized by the Workers' Compensation Board. It is available in both English and French.

This document is used to inform workers in New York of their right to choose a healthcare provider authorized by the Workers' Compensation Board. It is available in both English and Urdu.

This form is used for authorizing the release of limited health information in compliance with HIPAA regulations in New York. It is available in both English and Urdu languages.

This form is used for requesting a limited release of health information under HIPAA regulations in New York. It is available in both English and French languages.

This form is used for requesting a redetermination of extreme hardship for individuals residing in New York who are applying for immigration relief. The form is available in French.

This form is used to request a redetermination of extreme hardship in the case of a non-English speaking individual living in New York.

This form is used for making a claim for compensation in a death case in New York. It is available in French language.

This Form is used for filing a claim for compensation in a death case in New York, and it is available in Urdu language.

This document is used for recording the independent job search efforts made by a claimant in New York. It is available in Urdu language.

This form is used for filing a discharge or discrimination complaint in New York, available in Arabic language.

This form is used for biannual recertification of entitlement to benefits in New York. It is available in Urdu language.

This Form is used for biannual recertification to entitlement to benefits in New York. It is available in French.

This document is a Claimant's Authorization form used for disclosing workers' compensation records in New York. It is available in French.

This document is a French version of Form VDF-1 Loss of Wage Earning Capacity Vocational Data Form used in New York. It is used to collect data about the vocational history and wage earning capacity of individuals who have experienced a loss of income.

This document is used for recording job search efforts and contacts by claimants in New York. It is available in Urdu language.

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