Get Ny Rfa-1w 2022-2025

Filling out the NY RFA-1W form accurately is crucial for injured workers seeking assistance from the Workers' Compensation Board. This comprehensive guide provides step-by-step instructions to help you complete the form online, ensuring that your request is submitted correctly and efficiently.

Follow the steps to successfully complete your form.

1. Select the ‘Get Form’ button to access the NY RFA-1W document and open it in your preferred editor.
2. Begin by entering your claim information. Make sure to include the date of your injury or illness, and ensure that all communication references your WCB case number.
3. Fill in your personal details in the Injured Worker Information section. This includes your last name, first name, mailing address, state, city, zip code, daytime phone number, email address, social security number, date of birth, and gender.
4. Provide your employer's information, including the employer's name, mailing address, city, state, zip code, phone number, and federal tax ID. Specify whether the tax ID is a social security number (SSN) or employer identification number (EIN).
5. In the Reason for this Request section, check all applicable boxes that relate to your situation. Be sure to attach any necessary documents such as medical reports, letters, or additional forms as instructed. If documentation has already been submitted, note the form number or title and the submission date in the provided space.
6. If there are any other issues, such as new information, indicate this in the Other Issues section. Attach any relevant documents for clarification.
7. Read and understand the instructions for submitting the form. Ensure that the form and any attachments are submitted to the Workers' Compensation Board either by mail or email, as specified.
8. Sign and date the form to verify that the information provided is accurate and complete before submission.

Take the first step in your claim process by completing and submitting your NY RFA-1W online today.