Get Ny Db-150 2004-2025

This guide provides clear and detailed instructions on completing the NY DB-150 application for self-insurance under the Disability Benefits Law. Designed for users with varying levels of experience, this comprehensive guide will help you navigate each section of the form effectively.

Follow the steps to complete your application online.

1. Click ‘Get Form’ button to access the NY DB-150 application online. This will allow you to open the form in your preferred editing application, enabling you to complete it efficiently.
2. In Section 1, fill in the name of the applicant. Ensure this reflects the official business name registered with the New York State.
3. In Section 2, provide the principal office address of the applicant. Include street address, city, state, and zip code.
4. Complete Section 3 by entering the New York State Unemployment Insurance employer registration number assigned to the applicant.
5. In Section 4, input the federal employer identification number (EIN) of the applicant, which is essential for tax purposes.
6. In Section 5, fill in the telephone number where the applicant can be reached for further inquiries.
7. In Section 6, specify the desired effective date for the self-insurance coverage.
8. Section 7 requires information on current disability benefits coverage. In part (a), state the name of the insurance company providing coverage, and in part (b), provide the corresponding policy number.
9. In Section 8, briefly describe the nature of the business operations that the applicant undertakes.
10. For Section 9, choose how benefits will be paid to claimants. You can select between statutory benefits or benefits provided by a plan accepted under the applicable law.
11. In Section 10, indicate the classes of employees covered under this application, noting any exclusions.
12. Section 11 pertains to how the applicant intends to manage disability benefits matters, choosing whether to handle directly or through a representative.
13. If the applicant is a corporation, complete Section 12 with relevant dates and registration information, and attach the necessary documents.
14. For partnerships, fill out Section 13 with details about all partners and their home addresses, providing any required documentation.
15. In Section 14, if applicable, provide the home address of the sole proprietor.
16. Section 15 requests information related to associations. Attach the necessary lists and documents.
17. In Section 16, list the names of officers within the organization as required.
18. Sections 17 through 23 involve entering data regarding employee coverage and contributions for preceding and upcoming periods.
19. Finally, review the completed application for accuracy. Save your changes, and then download, print, or share the form as needed.

Complete your NY DB-150 application online today to ensure timely processing.