NYS Workers’ Compensation & DBL Common Forms
Workers’ Compensation:
- C-2 Employers Report of Accident
- C-3 Employee’s Claim for Compensation
- C-11 Employer’s Report of Injured Employee’s Change in Status or Return to Work
- C-22 Application for Approval of Non-Schedule Adjustment
- C-32 Settlement Agreement
- C-105.51 Notice of Election of a Corporation Which is Required to Have Coverage for its Employees Under The New York State Workers’ Compensation Law to Exclude the Sole Shareholder-Officer or One of the Two or Both Executive Officers-Shareholders of the Corporation from Such Coverage
- C-121 Claim for Compensation and Notice of Commencement of Third Party Action
- C-240 Employer’s Statement of Wage Earnings Preceding Date of Accident
- C-257 Claimant’s Record of Medical and Travel Expenses
New York State Disability
- 102 Information for Employer Regarding Disability Benefits Law
- DB 125 Employer Identification Card
- DB 212.5 Notice of Election To Voluntarily Exclude Spouse from Coverage
- DB 300 Notice of Proof of Claim for Disability Benefits By Unemployed Claimant
- DB 450 Notice and Proof of Claim for Disability Benefits
- DB 791 Reference Table of Employee Contributions By Pay Period For Employer Use