New York State Workers' Compensation Board Forms

This form is used for limited release of health information in compliance with HIPAA regulations in New York, specifically for individuals of Italian descent.

This form is used for Italian-speaking claimants in New York to document their independent job search efforts. It is called Form C-258.1I Claimant's Record of Independent Job Search Efforts.

This form is used for claimants in New York who want to make a statement regarding no fault or personal injury. It is available in Italian.

This form is used for injured workers in New York who speak Italian and need to request assistance. It is specifically for workers who have been injured on the job and require help.

This form is used for claiming compensation in a death case in New York, specifically for cases involving Italian citizens.

This form is used for authorizing the disclosure of a claimant's workers' compensation records in New York, specifically for individuals of Italian descent.

This document is used to record vocational data for individuals in New York who have experienced a loss of wage earning capacity. It is specifically designed for Italian speakers.

This form is used for registering participation in the World Trade Center rescue, recovery, and/or cleanup operations in New York. It is specifically for individuals of Italian nationality.

This document is for employers in New York to report work-related injuries or illnesses in Haitian Creole. It is used to provide necessary information about the incident.

This Form is used for requesting a redetermination of extreme hardship for individuals in New York who are Haitian Creole speakers.

This form is used for filing an affidavit to claim death benefits in New York, specifically for individuals who speak Haitian Creole.

This form is used for Haitian Creole-speaking individuals in New York to record their independent job search efforts. It helps claimants document their efforts in finding employment.

This Form is used for a settlement agreement release document in Haitian Creole language specific to New York. It is designed for claimants to release their rights in a legal settlement.

This document is a Claimant's Statement regarding no-fault or personal injury in New York, provided in Haitian Creole language.

This form is used for injured workers in New York who speak Haitian Creole to request assistance. It is available in the Haitian Creole language.

This form is used for claimants in New York who want to authorize the disclosure of their workers' compensation records. The form is available in Haitian Creole.

This Form is used for the registration of individuals participating in World Trade Center rescue, recovery, and cleanup operations. It is a sworn statement required by WCL 162 in New York. This specific version of the form is translated into Haitian Creole.

This form is used for employers in New York to report work-related injuries or illnesses. The form is available in Korean language.

This form is used for obtaining limited release of health information under HIPAA regulations in the state of New York. It is specifically designed for individuals who prefer to communicate in Korean.

This document is used for Korean-speaking claimants in New York to provide a statement regarding no fault or personal injury.

This document is a request form used by injured workers in New York who speak Korean to request assistance.

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

This Form is used to notify individuals in New York, who may be responsible for medical costs if their compensation claim is disallowed, if they fail to prosecute their claim, or if an agreement under WCL 32 is approved.

This form is used for recording independent job search efforts by claimants in New York who speak Bengali.

This form is used for notifying workers in New York who have the right to choose a health care provider authorized by the Workers' Compensation Board. This version of the form is in Bengali.

This Form is used for requesting a limited release of health information in compliance with HIPAA regulations in New York, translated into Bengali.

This form is used for a waiver agreement under Section 32 of the New York Workers Compensation Law for Haitian Creole speakers.

This form is used for a Waiver Agreement related to Section 32 of the Workers' Compensation Law in New York. It is available in Bengali.

This Form is used for claiming compensation in a death case in New York. It is available in Bengali.

This document is used for claimants in New York who need to provide a statement regarding no fault or personal injury. It is available in Bengali language.

This type of document, Form VDF-1B Loss of Wage Earning Capacity Vocational Data Form - New York (Bengali), is used to gather information about an individual's vocational data and loss of wage earning capacity. This form is specific to the state of New York and is available in the Bengali language for the convenience of Bengali-speaking residents.

This form is used for the Waiver Agreement under Section 32 of the Workers' Compensation Law in New York, which is available in Bengali.

This form is used for registering participation in the World Trade Center rescue, recovery, and/or clean-up operations in New York. It is available in Bengali language.

This document is used for submitting an Ancillary Medical Report in New York State. It is used to provide additional medical information related to a worker's compensation claim.

This Form is used for applying for approval of non-schedule adjustment in New York.