New York State Workers' Compensation Board Forms
Documents:
621
This form is used for employers in New York who want to apply for voluntary coverage for a class of employees who are not required by law to have disability and paid family leave benefits. There is no employee contribution required.
PDF 
Word
This form is used for providing additional information and details to supplement a Certificate of Insurance in the state of New York.
This form is used for applying for board review in the state of New York, but it is available in French.
This document is an application form for requesting a board review in New York. It is available in Urdu language.
This form is used for submitting a rebuttal in response to an application for board review in New York. It is available in Chinese.
This form is used for rebutting an application for board review in New York. It is available in French.
This form is used for filing an application for reconsideration or full board review in New York. It is available in Russian language.
This form is used for applying for reconsideration or full board review in New York. It is available in French.
This Form is used for submitting an Application for Reconsideration/Full Board Review in Arabic language in the state of New York.
This form is used for applying for reconsideration or a full board review in New York. It is available in Urdu language.
This document is used for submitting a rebuttal to an application for reconsideration or full board review in New York for Chinese speakers.
This form is used for submitting a rebuttal to an application for reconsideration or full board review in New York. It is available in Bengali language.
This document is used for submitting a rebuttal to an application for reconsideration or full board review in New York. It is available in French.
This document allows you to submit a rebuttal for a reconsideration or full board review in New York. It is available in Urdu language.
This form is used for claiming benefits in a death case for volunteer ambulance workers in the state of New York.
