New York State Workers' Compensation Board Forms

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 Form is used for injured workers in New York who need to request assistance. The form is available in French.

This Form is used for self-insurers in New York to report their payroll for all operations.

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.

This Form is used for employers in New York to report the wages earned by an employee before their injury or illness.

This document is a notice that informs claimants in New York that they must schedule their diagnostic tests and examinations through a network provider.

This Form is used for physicians in New York to apply for designation as an impartial specialist.

This form is used for providing notice to individuals in New York who may be responsible for medical costs if their compensation claim is not pursued, disallowed, or if an agreement is approved. It is written in Russian.

This document is a notice that informs individuals in New York (Chinese) of their potential responsibility for medical costs if their compensation claim is unsuccessful or if an agreement under WCL 32 is approved.

This form is used to notify individuals in New York of their potential responsibility for medical costs in the event that their compensation claim is disallowed or if an agreement pursuant to WCL 32 is approved. The form is available in Korean.

This form is used for notifying individuals in New York (Yiddish) that they may be responsible for medical costs if their compensation claim is denied, agreement pursuant to WCL 32 is approved, or if they fail to prosecute their claim.

This Form A-9 is used in New York to inform individuals that they may be responsible for medical costs if their compensation claim is not pursued, disallowed, or if an agreement under WCL 32 is approved.

This type of document is a Section 32 Waiver Agreement for claimant release in the state of New York. The form is available in Russian.

This form is used for a waiver agreement in New York where a Polish person is releasing their claim.

This form is used for obtaining a waiver agreement and release for claimants in New York who prefer Chinese language.

This document is used for obtaining a waiver agreement for claims in New York that releases the claimant from liability. It is available in Arabic.

This Form is used for a settlement agreement related to workers' compensation indemnity payments only in the state of New York.

This form is used for political subdivisions in New York to notify the state of their election to self-insure for various purposes.