Get Arch Nys Disability Form

This guide provides clear and supportive instructions on how to complete the Arch Nys Disability Form online. By following these steps, users can efficiently fill out their claim for disability benefits while ensuring all necessary information is accurately provided.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Carefully read the initial instructions. Ensure you understand the requirements for Part A, which is the Claimant's Statement.
3. In Part A, begin by entering your full name in the designated field. Make sure to provide your first, middle, and last name clearly.
4. Next, provide your full address, including street number, street name, apartment number (if applicable), city, state, and zip code.
5. Enter your telephone number in the specified format. This should be a number where you can be reached easily.
6. Fill in your Social Security Number accurately to avoid any delays in processing.
7. Provide your date of birth using the correct format for month, day, and year.
8. Indicate your marital status by checking 'Yes' or 'No' in the appropriate section.
9. Describe the nature of your disability in the following section. If applicable, include details about how, when, and where the injury occurred.
10. State the exact date you became disabled. Use the month, day, and year format.
11. Indicate whether you worked on the day you became disabled by checking ‘Yes’ or ‘No’. If you have worked since that day, provide the relevant dates.
12. List the name of your last employer, along with job title and business address. If you had multiple employers in the last eight weeks, include all names.
13. Give your average weekly wages, including any bonuses or additional compensation you received.
14. For the period of disability covered by your claim, respond to questions regarding any wages or benefits you are currently receiving.
15. Note any previous disability benefits received within the past 52 weeks, including dates.
16. Read the declaration statement carefully and sign where required. If someone else is signing on your behalf, provide details about their relationship and contact information.
17. Ensure that your health care provider completes Part B of the form, as it is crucial for the claim.
18. Once the form is fully completed, you can save your changes, download a copy, print it out, or share it as needed.

Complete your Arch Nys Disability Form online today to ensure timely processing of your disability claim.