Get Ny Db-681 2020-2025

The NY DB-681 form is essential for self-insured entities to report on disability and paid family leave benefits. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the NY DB-681 online.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Enter the employer's full legal name, including designations such as 'Inc.' or 'LLC', in the appropriate field.
3. Provide the employer's mailing address, which should be the headquarters or primary location of the self-insured entity.
4. Fill out the Federal Employer Identification Number (FEIN) and Self-Insured ID# in the designated sections.
5. Complete the chart detailing the number of eligible New York employees covered by self-insurance and the corresponding payroll amounts for disability and paid family leave benefits.
6. Indicate if there have been any changes in legal status or ownership by checking 'Yes' or 'No' and attach the necessary documents if applicable.
7. Provide the details of the primary contact for disability benefits, including their name, title, address, phone number, and email.
8. If there is a different primary contact for paid family leave, input their details in the respective fields.
9. List any approved active subsidiaries in the self-insurance program, attaching additional sheets if needed.
10. Select the claims administration details, specifying if it is self-administered or administered by a licensed claims administrator.
11. Ensure that the form is signed by an authorized official of the self-insured entity, and remember to include the date of signing.
12. After filling out the form, save your changes, and proceed to download, print, or share the completed document as necessary.

Complete your NY DB-681 online form today to ensure compliance with reporting requirements!