EMPLOYER 'S STATEMENT FOR THE PURPOSE OF TERMINATING STATUS AS A COVERED EMPLOYER DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW1. EMPLOYER 'S NAME2. EMPLOYER 'S FEINEMPLOYER 'S ADDRESS CITY, STATE.

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How to fill out the NY DB-112 online

The NY DB-112 is an essential document for employers looking to terminate their status as a covered employer under the Disability and Paid Family Leave Benefits Law. This guide provides step-by-step instructions to assist you in completing the form accurately.

Follow the steps to complete the form successfully.

  1. Click ‘Get Form’ button to access the form online.
  2. Enter the employer's name in the designated field at the top of the form. Ensure that the name matches the official business records to avoid discrepancies.
  3. Fill in the employer's Federal Employer Identification Number (FEIN) in the next field. This unique identifier is crucial for the filing process.
  4. Complete the employer's address section, including the city, state, and ZIP code. This information is vital for communication purposes.
  5. If different from the previously provided name, indicate the business or trade name in the next field.
  6. Provide the responses to the statements regarding employment status over the past calendar year. Answer each statement accurately based on your employment records.
  7. If applicable, indicate whether employees were required to contribute toward disability and paid family leave benefits. This is done by checking 'Yes' or 'No' accordingly.
  8. Report any excess employee contributions in the designated field. If there are none, simply enter 'None'.
  9. Sign and date the form, ensuring the signature is from the owner, partner, or an authorized officer of the corporation.
  10. Include a valid telephone number and title in the corresponding fields for further reference.
  11. Review the completed form thoroughly for accuracy. Once satisfied, you can save changes, download a copy, print it, or share it as needed.

Complete your documents online to ensure a smooth and efficient process.

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