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Get Ny Wtc-12 2016
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How to fill out the NY WTC-12 online
This guide provides comprehensive instructions for completing the NY WTC-12 form online. By following these steps, you will be able to accurately register your participation in World Trade Center rescue, recovery, and clean-up operations.
Follow the steps to successfully complete the NY WTC-12 form.
- Click the ‘Get Form’ button to obtain the NY WTC-12 online and open it in your selected editor.
- Begin by entering your current residential address, including apartment number if applicable. Provide your street number, street name, city, state, and zip code. If your mailing address differs from your residential address, include that as well, along with your telephone number.
- In this section, affirm your participation in the World Trade Center rescue, recovery, and clean-up operations between September 11, 2001, and September 12, 2002. Clearly indicate whether your role was as an employee or a volunteer.
- If you participated as a volunteer, list any evidence of your activities, such as badges, letters, statements, or pictures that support your involvement.
- Complete the table by specifying the dates and locations of your participation. Include a brief description of the work you performed at each location, as well as the name and address of your employer or the volunteer agency you worked with.
- Indicate whether you have previously filed a workers' compensation claim with the Board related to your participation. If so, provide the date you filed the claim and the WCB case number.
- Acknowledge that submitting this Sworn Statement does not equate to filing a claim for workers' compensation benefits. To correctly file a claim, you will need to submit additional forms specified by the Board.
- Complete the Sworn Statement and ensure all information is accurate and truthful. Once verified, sign the document in front of a notary public.
- Finally, file the original Sworn Statement with the Workers' Compensation Board at the provided mailing address by the specified deadline.
Complete your documents online today to ensure timely registration.
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To get workers' comp in NY, first ensure that your injury qualifies under state laws. Then, notify your employer and complete the required paperwork, including the C-3 form. NY WTC-12 simplifies the entire process by offering resources to help you understand your rights and the necessary steps to take.
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