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Form A-9 Notice That You May Be Responsible for Medical Costs in the Event of Failure to Prosecute, or if Compensation Claim Is Disallowed, or if Agreement Pursuant to Wcl 32 Is Approved - New York (Yiddish)
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York.
The document is provided in Yiddish. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form A-9?A: Form A-9 is a notice that you may be responsible for medical costs.
Q: When am I responsible for medical costs?A: You may be responsible for medical costs if there is a failure to prosecute, if your compensation claim is disallowed, or if an agreement pursuant to Wcl 32 is approved.
Q: Is this form specific to New York?A: Yes, this form is specific to New York.
Q: Is this form available in Yiddish?A: Yes, this form is available in Yiddish.
Form Details:
- Released on November 1, 2021;
- The latest edition provided by the New York State Workers' Compensation Board;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
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.
