New York State Workers' Compensation Board Forms

This form is used for the limited release of health information in compliance with HIPAA regulations in New York. It allows individuals to authorize the disclosure of specific medical records to a designated party.

This form is used for doctors in New York to report on the patient's Maximum Medical Improvement (MMI) and Permanent Partial Impairment (PPI).

This form is used for revoking the election of an incorporated religious, charitable, educational, or U.S. war veterans organization to bring executive officers under the coverage of the New York Workers' Compensation Law in New York.

This form is used for notifying an incorporated religious, charitable, educational, or U.S. war veterans organization in New York about their election to bring executive officers under the coverage of the New York Workers' Compensation Law.

This Form is used for filing requests for assistance by an injured worker in New York. (Spanish)

This Form is used for injured workers in New York who need assistance. It is available in Polish.

This Form is used for reporting depreciation of IRC Section 168(K) property in New York State. It provides a schedule for calculating and reporting depreciation for tax purposes.

This form is used for reporting the income tax withheld from your wages in the state of New York.

This form is used for filing a stipulation in New York, written in Chinese. It is an agreement between parties involved in a legal case.

This form is used for a stipulation in New York, written in Russian.

This document is a stipulation form used in the state of New York with an Italian translation. It is used for making agreements between parties in a legal case.

This form is used for stipulating agreements in New York courts with parties who speak Korean.

This form is used for submitting a stipulation in New York written in Yiddish.

This form is used for submitting a stipulation in New York, specifically for individuals who speak Haitian Creole. The form is available in Haitian Creole language to ensure clear communication and understanding.

This document is a stipulation form used in New York in the Bengali language. It is used for formal agreements or arrangements between parties involved in a legal matter.

This document is a stipulation form written in Arabic that is used in the state of New York. It is used to make agreements or settle disputes in legal cases.

This document is a special form used in New York for fast-track hearings to report unresolved issues or problems.

This form is used to document unresolved issues in expedited hearings in New York, specifically for cases involving Haitian Creole speakers.

This document is used for presenting the agreed upon findings and awards for a proposed conciliation decision. It is specifically for represented claimants in New York who prefer Polish language.

This form is used for represented claimants in New York to document the agreed upon findings and awards for a proposed conciliation decision. It is written in Russian.

This form is used by represented claimants in New York (Italian) to record agreed upon findings and awards for a proposed conciliation decision.

This form is used for presenting agreed upon findings and awards for a proposed conciliation decision in New York for claimants who are represented. The form is available in Chinese.

This form is used for represented claimants in New York, who have reached an agreement regarding the findings and awards for a proposed conciliation decision. The form is available in Korean language.

This document is used for recording the agreed upon findings and awards for proposed conciliation decisions in New York for represented claimants who speak Haitian Creole.

This Form is used for recording agreed upon findings and awards for a proposed conciliation decision exclusively for represented claimants in New York. It is available in the Bengali language.

This form is used for New York (Yiddish) represented claimants to state agreed upon findings and awards for a proposed conciliation decision.