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Get NJ WDS-1 2014

INSTRUCTIONS BEFORE COMPLETING THE ATTACHED FORM, CLAIM FOR DISABILITY BENEFITS – DS-1 1. Complete both sides of the claimant’s portion of this form (Part A & A1.) YOU ARE RESPONSIBLE for having Part B completed by your doctor and Part C by your last employer. If you have worked for more than one employer during the past year, you may copy Part C for completion by the other employer(s) to avoid processing delays. Any missing or incorrect entries on this form will delay processing of your cla.

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