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Forms - NYSIF

Access frequently-used workers' compensation and disability benefits forms below. Many of the forms link directly to the Workers' Compensation Board website.

https://ww3.nysif.com/en/FooterPages/Column1/Forms

Essential Forms - NYSIF

Forms C-240 C-11 and C-107 are essential to avoid delays in claims payments reimbursements and penalties.

https://ww3.nysif.com/Home/Employer/WCpolicyholder/AboutYourPoli...

PFL Form - Request for Family Care Leave

Jul 31 2024 ... number. Complete your forms and attach the required documentation. Complete the Request for Paid Family Leave Form PFL-1 .

https://ww3.nysif.com/-/media/Files/DISABILITY_BENEFITS/PDF/2024...

NYSIF Search

Workers' Comp Claim Forms - Injured Worker Claimant ... Employee's Claim for Compensation - filed by the employee when making a claim within two years of injury ...

https://ww3.nysif.com/SearchResults?q=FORMS

eSignature Forms

Oct 17 2017 ... The New York State Insurance Fund has decided to make its 10 most commonly-used workers' compensation forms available for electronic ...

https://ww3.nysif.com/en/FooterPages/Column1/AboutNYSIF/NYSIF_Ne...

Filing a Claim - NYSIF

To file a Disability Benefits claim an employee must complete NYSIF Form DB-450 and return it to NYSIF within 30 days of the onset after the start of the off- ...

https://ww3.nysif.com/Home/Employer/DBpolicyholder/AboutClaims/D...

PFL Form - Request for Family Care Leave

to find out their Disability Benefits Paid Family Leave insurance company and policy number. Complete your forms and attach the required documentation. Complete ...

https://ww3.nysif.com/-/media/Files/DISABILITY_BENEFITS/PDF/2023...

About Your Disability Benefits Claim - NYSIF

Your completed claim form should be submitted to your most recent employer or NYSIF within 30 days after you become sick or disabled. Mail completed NYSIF DB- ...

https://ww3.nysif.com/Home/Claimant/DBClaimant/FilingAClaim

NYSIF Search

Access frequently-used workers' compensation and disability benefits forms below. https ww3.nysif.com Home SearchResults q new york st-120 form ...

https://ww3.nysif.com/Home/SearchResults?q=forms&count=10&offset...

About Your Paid Family Leave Claim - NYSIF

How do I file a PFL claim Everyone must complete Request for Paid Family Leave Form PFL-1 Complete the appropriate additional forms depending on the type ...

https://ww3.nysif.com/en/Claimant/DBClaimant/PaidFamilyLeaveClmn...