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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.

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Essential forms - NYSIF

forms C-240, C-11 and C-107 are essential to avoid delays in claims payments, reimbursements and penalties. A C-105 Notice of Compliance is required by law to be posted in all business locations.

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

Filing a Claim - NYSIF

To file a Paid Family Leave claim, an employee must complete NYSIF Form PFL-1, along with additional PFL forms for the type of leave being requested. See more details on our PFL claimant page.

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

NYSIF

NYSIF Extreme Heat PPE Premium Credit Program Beat the heat. Protect your workforce. NYSIF is offering a one-time credit to workers’ compensation policyholders for the purchase of essential Personal Protective Equipment (PPE) for extreme heat. Benefits Receive up to 10% credit of annual premium on the purchase of heat-related PPE, with a maximum reimbursement of $1,000 Offset expenses for ...

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Claimant Information Packet - NYSIF

Employers must give injured workers a Claimant Information Packet (available in several languages under Workers' Comp Claim forms - Employer) when filing claims.

https://ww3.nysif.com/Home/Employer/WCpolicyholder/AboutClaims/C...

DB-450.pdf - NYSIF

This form is available on the WCB website (www.wcb.ny.gov) and can be accessed by clicking the "forms" link. If you do not have access to the internet please call (877) 632-4996. In lieu of Form OC-110A, you may also submit an original signed, notarized authorization letter.

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

Payroll Reporting - NYSIF

Disability benefits policyholders who previously reported payroll via a paper form will automatically receive payroll report forms in the mail for the next reporting period.

https://ww3.nysif.com/Home/Employer/DBpolicyholder/AboutYourBill...

Paid Family Leave - NYSIF

forms/Resources: The forms below are hosted by the state's Paid Family Leave website. Employee Notice of Paid Family Leave Payroll Deduction for 2025 Employer’s Application for Voluntary Coverage (No Employee Contribution) (PFL-135) Employer’s Application for Voluntary Coverage (Employee Contribution Required) (PFL-136)

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

PFL Form - Request for Family Care Leave - NYSIF

Submit in one way only: fax to 518.437.5201, e-mail to DBClaims@nysif.com, or mail to NYSIF, PO Box 66699, Albany, NY 12206. Keep a copy of all documents for your records. It is your responsibility to submit the forms to NYSIF. It is not your employer’s responsibility.

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

EMPLOYER’S REQUEST FOR REIMBURSEMENT - NYSIF

INSTRUCTIONS This form is used principally as evidence of a claim for reimbursement by an employer for monies advanced to a claimant on account of compensation due under the provisions of the Workers’ Compensation Law.

https://ww3.nysif.com/-/media/Files/CLAIMS/PDF/C-107.ashx