Get Ny Db-136 2019-2025

Filling out the NY DB-136 form is an essential step for employers seeking voluntary coverage for disability and paid family leave benefits. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the NY DB-136 form online.

1. Press the 'Get Form' button to access the NY DB-136. This will allow you to open the document in an editable format.
2. Begin by entering the name of your business and the name under which it is conducted in the designated fields. Provide your telephone number and address to ensure accurate communication.
3. Input your Federal Employer's Identification Number (FEIN) or, if unavailable, your Social Security Number. Additionally, indicate the total number of employees you have.
4. Specify the number of employees within the class for whom disability and paid family leave benefits are not required by law.
5. In section A, indicate whether your business qualifies as a covered employer as defined in Section 202 of the New York State Disability and Paid Family Leave Benefits Law by checking the appropriate box.
6. Continue to section B and mark your election to provide benefits under Section 212 of the law. Specify the employees covered, the benefits provided, and the method through which benefits will be administered.
7. In section C, confirm the agreement to provide payment of benefits for at least one year and to notify the relevant parties at least ninety days prior before discontinuing coverage.
8. Section D requires you to certify that more than half of the employees for the class have agreed to contribute, along with other required information about contributions.
9. On the reverse side of the form, complete the affirmation section where an authorized official must sign, date, and provide their contact information.
10. If applicable, have the authorized representatives of employees sign the certificate confirming the election was made at least thirty days prior to submitting the application.
11. Once all required fields are filled out, you can save the changes, download, print, or share the completed form as needed.

Complete your NY DB-136 form online today to ensure compliance and protect your employees' benefits.