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Form CE-200APPLY "Application for Certificate of Attestation of Exemption" - New York

Rate (4.4 / 5) 9 votes
Size: 321 KB
6 pages

New York State entities who want to be exempted from liability to carry their workers' compensation or disability benefits insurance may use this form to apply for the exemption.

Form WTCVol-3 "World Trade Center Volunteer's Claim for Compensation" - New York

Rate (4.6 / 5) 56 votes
Size: 1 MB
2 pages

Form DD-1 "Direct Deposit Authorization Form - Sample" - New York

Rate (4.5 / 5) 82 votes
Size: 1 MB
2 pages

Form C-4 "Doctor's Initial Report" - New York

Rate (4.7 / 5) 20 votes
Size: 1 MB
5 pages

Form OT/PT-4 "Occupational/ Physical Therapist's Report" - New York

Rate (4.6 / 5) 53 votes
Size: 404 KB
2 pages

Form IME-7 "Statement of Registration" - New York

Rate (4.4 / 5) 121 votes
Size: 1 MB
4 pages

Form HP-1 "Request for Decision on Unpaid Medical Bill(S)" - New York

Rate (4.3 / 5) 13 votes
Size: 1 MB
2 pages

Form C-3 "Employee Claim" - New York (Haitian Creole)

Rate (4.5 / 5) 24 votes
Size: 429 KB
4 pages

Formulario C-3 "Reclamo Del Empleado" - New York (Spanish)

Rate (4.3 / 5) 26 votes
Size: 387 KB
4 pages

Form LAC-1 "Access to Services in Your Language: Complaint Form" - New York

Rate (4.6 / 5) 20 votes
Size: 2 MB
1 page

Form MR/IME-1 "Health Provider's Application for Authorization Under the Workers' Compensation Law" - New York

Rate (4.4 / 5) 12 votes
Size: 176 KB
2 pages

Form HIMP-1 "New York State Workers' Compensation Board Health Insurance Matching Program" - New York

Rate (4.5 / 5) 34 votes
Size: 1 MB
2 pages

Form IME-5 "Claimant's Notice of Independent Medical Examination" - New York

Rate (4.8 / 5) 24 votes
Size: 2 MB
2 pages

Form IME-4 "Independent Examiner's Report of Independent Medical Examination" - New York

Rate (4.4 / 5) 9 votes
Size: 2 MB
2 pages

Form MG-1 "Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response" - New York

Rate (4.4 / 5) 16 votes
Size: 2 MB
3 pages

Form MG-2 "Attending Doctor's Request for Approval of Variance and Carrier's Response" - New York

Rate (4.8 / 5) 20 votes
Size: 2 MB
5 pages

Form RFA-2 "Request for Further Action by Carrier/Employer" - New York

Rate (4.8 / 5) 23 votes
Size: 1 MB
2 pages

Form AFF-1 "Affidavit for Death Benefits" - New York

Rate (4.6 / 5) 68 votes
Size: 409 KB
11 pages

Form AFF-1 "Affidavit for Death Benefits" - New York (Yiddish)

Rate (4.6 / 5) 16 votes
Size: 276 KB
11 pages

Form PS-4 "Attending Psychologist's Report" - New York

Rate (4.4 / 5) 19 votes
Size: 1 MB
2 pages

Form C-5 "Attending Ophthalmologist's Report" - New York

Rate (4.7 / 5) 23 votes
Size: 1 MB
2 pages

Form IME-3 "Independent Examiner's Report of Request for Information/Response to Request Regarding Independent Medical Examination" - New York

Rate (4.5 / 5) 50 votes
Size: 2 MB
1 page

Form IS-1 "Physician's Application for Designation as an Impartial Specialist" - New York

Rate (4.3 / 5) 52 votes
Size: 1 MB
2 pages

Form IS-4 "Report of Impartial Specialist Examination or Record Review" - New York

Rate (4.7 / 5) 77 votes
Size: 2 MB
2 pages

Form VDF-1 "Loss of Wage Earning Capacity Vocational Data Form" - New York (Chinese)

Rate (4.5 / 5) 22 votes
Size: 1 MB
2 pages

Form DT-1 "Notice That Claimant Must Arrange for Diagnostic Tests & Examinations Through a Network Provider" - New York

Rate (4.6 / 5) 24 votes
Size: 1 MB
1 page

Form VDF-1 "Loss of Wage Earning Capacity Vocational Data Form" - New York

Rate (4.8 / 5) 94 votes
Size: 2 MB
2 pages

Form VAW-3 "Volunteer Ambulance Worker's Claim for Benefits" - New York

Rate (4.6 / 5) 12 votes
Size: 2 MB
2 pages

Form VF-3 "Volunteer Firefighter's Claim for Benefits" - New York

Rate (4.6 / 5) 20 votes
Size: 2 MB
2 pages

Form MR-4 "Impartial Specialist's Report of Medical Records Review" - New York

Rate (4.8 / 5) 100 votes
Size: 1 MB
2 pages

Form MD-1 "Attending Doctor's Request for Medical Authorization Determination" - New York

Rate (4.4 / 5) 67 votes
Size: 1 MB
2 pages

Form ADR-1 "Report of Work-Related Injury or Occupational Disease" - New York

Rate (4.8 / 5) 88 votes
Size: 1 MB
2 pages

Form ADR-2 "Alternative Dispute Resolution Program Final Disposition or Settlement of Claim" - New York

Rate (4.5 / 5) 35 votes
Size: 2 MB
2 pages

Form MD-3 "Carrier's/Self-insured Employer's Objection to Attending Doctor's Request for Medical Authorization Determination" - New York

Rate (4.5 / 5) 59 votes
Size: 1 MB
2 pages

Form FCE-4 "Practitioner's Report of Functional Capacity Evaluation" - New York

Rate (4.4 / 5) 19 votes
Size: 1 MB
2 pages

Form SI-1 "Application for Self-insurance" - New York

Rate (4.7 / 5) 14 votes
Size: 1 MB
2 pages