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[PDF File]New York State Workers' Compensation Board Application for ...
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CE-200APPLY (2/2009) - 1 - New York State Workers' Compensation Board Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. For NYS workers’ compensation exemption, this application may only be completed by entities with no employees or
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[PDF File]STATE OF NEW YORK WORKERS’ COMPENSATION BOARD …
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named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law.
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[PDF File]Workers’ Compensation Requirements in New York State
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in New York State are required to carry a full, statutory New York State workers' compensation insurance policy. An employer has a full, statutory New York State workers' compensation insurance policy when New York is listed in Item "3A" on the Information Page of the employer's workers' compensation insurance policy.
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[PDF File]STATE & MUNICIPAL
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compensation and disability benefits insurance coverage requirements. Historically, the WC/DB-100 exemption forms were valid for multiple permits, licenses or contracts where the applicant applied, had to be notarized, and had to be stamped by the New York State Workers’ Compensation Board. Effective Dec. 1, 2008, this process will change.
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[PDF File]Employee Claim C-3
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State of New York -Workers' Compensation Board C-3.3 WCB Case No. (if you know it):_____ To Claimant: If you received treatment for a previous injury to the same body part or for an illness similar to the one described in your current Claim, fill out this form.
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[PDF File]STATE OF NEW YORK - WORKERS' COMPENSATION BOARD
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Prescribed by Chair, Workers' Compensation Board. STATE OF NEW YORK - WORKERS' COMPENSATION BOARD. CHECK ONE. Address CLAIMANT. ATTORNEY OR REPRESENTATIVE CARRIER. EMPLOYER* NOTICE TO ATTORNEY OR REPRESENTATIVE: 1. This form may be used by an . original, substituted or additional. attorney or representative. Check appropriate box on top of form. 2.
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[PDF File]New York Compensation Insurance Rating Board
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I write to inform you that the New York State Department of Financial Services (“DFS”) approved the filing made by the New York Compensation Insurance Rating Board (“Rating Board”), in accordance with New York State Insurance Regulation 119, 11 NYCRR 151-7.2(b). New York State Insurance Regulation 119 requires the Rating Board to ...
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Workman s compensation board new york state