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 624 State Forms found

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IMPARTIAL SPECIALIST'S REPORT OF MEDICAL RECORDS REVIEW

 MR-4 (1-11)

INITIAL APPLICATION FOR LICENSE TO APPEAR ON BEHALF OF CLAIMANT

 OC-401.1 (9-07)

INITIAL APPLICATION TO TAKE LICENSE REPRESENTATIVE EXAM TO APPEAR ON BEHALF OF CLAIMANTS OR TO APPEAR ON BEHALF OF OR REPRESENT CARRIERS

 OC-409 (2-12)

Limited Release of Health Information (HIPAA)

 C-3.3 (12-09)

Loss of Wage Earning Capacity Vocational Data Form

 VDF-1 (1-12)

DISCONTINUED BY STATE NOTICE OF DISABILITY BENEFITS PAYMENT

 DB-455. DEACTIVATED 3-99

NOTICE OF ELECTION BY A POLITICAL SUBDIVISION OR FIRE DISTRICT TO SECURE COMPENSATION AS A SELF-INSURER

SI-26 (11/16)

Notice of Election of a Corporation which is Required to have Disability and Paid Family Leave Benefits Coverage

DB-212.3 (10-17)

NOTICE OF ELECTION OF A MUNICIPAL CORPORATION OR OTHER POLITICAL SUBDIVISION OF THE STATE TO BRING EXECUTIVE OFFICERS UNDER THE COVERAGE OF THE NEW YORK WORKERS' COMPENSATION LAW

 C-105.31 (1-04)

NOTICE OF ELECTION OF A NOT-FOR-PROFIT CORPORATION OR A NOT-FOR-PROFIT UNINCORPORATED ASSOCIATION TO EXCLUDE AN UNSALARIED EXECUTIVE OFFICER FROM COVERAGE PURSUANT TO SECTION 54, SUBDIVISION 6 OF

C-105.52 (1-04)

NOTICE OF ELECTION OF A PARTNERSHIP, LIMITED LIABILITY PARTNERSHIP, PROFESSIONAL LIMITED LIABILITY PARTNERSHIP, LIMITED LIABILITY COMPANY, PROFESSIONAL LIMITED LIABILITY COMPANY OR SOLE PROPRIETOR

 C-105.32 (4-04)

NOTICE OF ELECTION TO PROVIDE WORKERS' COMPENSATION BENEFITS TO PARTICIPANTS IN A SHELTERED WORKSHOP

 C-105.54 (3-99)

NOTICE OF ELECTION TO VOLUNTARILY EXCLUDE SPOUSE FROM COVERAGE PURSUANT TO SECTION 212, SUBDVISION 5 OF THE NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW

 DB-212.5 (10-17)

NOTICE OF RETAINER AND APPEARANCE ON BEHALF OF EMPLOYER

 OC-406 (1-18)

NOTICE OF RETAINER AND SUBSTITUTION

 OC-400 (1-23)
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