This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form A-9?
A: Form A-9 is a notice regarding potential responsibility for medical costs.
Q: What does Form A-9 cover?
A: Form A-9 covers situations where there is a failure to prosecute, a disallowed compensation claim, or an approved agreement according to WCL 32.
Q: Is Form A-9 available in English and Spanish?
A: Yes, Form A-9 is available in both English and Spanish.
Form Details:
Download a fillable version of Form A-9 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.