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  • Ny State Insurance Fund Employers Application Form

Get Ny State Insurance Fund Employers Application Form

Obtain insurance in the New York State Insurance Fund at less than the proper rate for ... and Employers' Liability Application. Page 2 of 8. UE-4m (Revised 04- 2009i). NY .... Copies of New York.

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If you are a Disability or Paid Family Leave claimant and have submitted a claim to NYSIF, but do not yet have a NYSIF claim number, please email DBClaims@nysif.com for a status update or call 866.697. 4332 for further assistance.

Filing Disability Benefits Claims 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-the-job injury or illness. For approved claims, Disability Benefits begin on the eighth day of disability.

It protects employers from liability for on-the-job injury or illness resulting in employee disability or death, and provides injured workers with monetary relief and medical benefits; in death cases, it provides survivor benefits to dependents.

If you are using this form because you became disabled after having been unemployed for more than four (4) weeks, your completed claim MUST be mailed to: Workers' Compensation Board, Disability Benefits Bureau, PO Box 9029, Endicott, NY 13761-9029.

Payroll providers can withhold these SDI amounts from employees' wages, but will not collect those funds from the company, nor pay those funds to the carrier. It is the company's responsibility to pay their total SDI premiums to the carrier, including any amounts withheld from their employees.

Report the injury online via NYSIF eFROI (electronic first report of injury). Use our eFROI Worksheet to help you submit your report or view our comprehensive eFROI User Guide. Call the 24/7 Accident Reporting Hotline phone at 1-844-879-2692.

NY State Insurance Fund ( NYSIF ) NYSIF is a not-for-profit agency of the State of New York that offers workers' compensation, New York State disability benefits and Paid Family Leave insurance.

Please be sure to include your policy number or claim number in any correspondence....Contact Us. EmailMailCallcustomerservice@nysif.comNYSIF PO Box 66699 Albany, NY 12206888.875.57902 more rows

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232