235709
This form is used for filing a rescission offer in North Dakota.
This form is used for obtaining a Certificate of Professional License in North Dakota. It is a document that verifies the licensure of professionals in various fields.
This form is used for obtaining a surety bond for professional fundraisers in North Dakota.
This Form is used for registering the identity of landlords in the state of New Jersey.
This Form is used for Attending Doctors in New York to request a determination for medical authorization.
This Form is used for filing a claim for compensation in a death case in New York for Chinese speakers.
This Form is used for filing a claim for compensation in a death case in New York, specifically for individuals who speak Haitian Creole.
This Form is used for filing a claim for compensation in a death case in New York. The form is available in Korean.
This form is used for the impartial specialist to report and review medical records in New York.
This form is used for notifying the election of a municipal corporation or other political subdivision in New York to bring executive officers under the coverage of Workers' Compensation Law (WCL).
This Form is used for notifying the New York State Workers' Compensation Board of the election of a partnership, limited liability partnership, limited liability company, or sole proprietorship to bring partners, members, or self-employed persons under the coverage of the New York State Workers' Compensation Law.
This form is used for revoking the election of a municipality or political subdivision in New York to bring executive officers under Workers' Compensation Law coverage.
This document is used for notifying the election of a not-for-profit corporation or association to exclude an unsalaried executive officer from workers' compensation coverage according to Section 54, Subdivision 6 of the Workers' Compensation Law in New York.
This form is used for revoking the election of a not-for-profit corporation or unincorporated association in New York to exclude an unsalaried executive officer from coverage.
This form is used for employers in New York who want to elect to provide workers' compensation benefits to participants in a sheltered workshop.
This form is used for revoking the election to exclude the sole shareholder or two executive officers from compensation coverage in New York.
This form is used for applying to take the License Representative Exam in New York for the first time.
This document is used to notify the responsible political subdivision of an injury or death of a volunteer ambulance worker in New York.
This Form is used for reporting loss of wage earning capacity and vocational data in New York.
This type of document, VDF-1 Loss of Wage Earning Capacity Vocational Data Form, is used in New York to gather vocational data related to loss of wage earning capacity. The form is available in Chinese language.
This Form is used for reporting a loss of wage earning capacity and vocational data in New York for those who speak Haitian Creole.
This form is used for reporting and collecting data related to the loss of wage earning capacity in New York. It is specifically designed for Korean-speaking individuals.
This form is used to notify a political subdivision in New York about an injury or death of a volunteer firefighter.
This form is used for biannual recertification of entitlement to benefits in the state of New York. It is used to verify and update information regarding eligibility for benefits.
This document is used for electronically attaching additional information or files to a submission or application in the state of New York.
This form is used to notify the chair of a health provider's and insurer's decision to withdraw their request for arbitration in New York.
This form is used for reporting an independent medical examination in response to a request for information in New York.
This form is used to notify individuals in New York that they may be responsible for medical costs if their compensation claim is disallowed or if an agreement pursuant to Wcl 32 is approved. The form is available in both English and Spanish.
This document notifies you that you may be responsible for medical costs if your compensation claim is denied or if you fail to prosecute it. It is available in English and Chinese.
This form is used for notifying individuals that they may be responsible for medical costs if their compensation claim is not pursued, or if it is disallowed, or if an agreement under Wcl 32 is approved. It is available in English and Haitian Creole.
This form is used to notify individuals in New York that they may be responsible for medical costs if their compensation claim is disallowed or if an agreement according to WCL 32 is approved. It contains both English and Italian translations.