Get Ny Db-680 2016-2025

The NY DB-680 form is essential for reporting claims, benefits, and covered payrolls to the Workers' Compensation Board under the Disability Benefits Law. This guide provides clear and simple instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the NY DB-680 online.

1. Press the ‘Get Form’ button to access the NY DB-680 online form and open it in your document editor.
2. Begin by entering the total number of initial indemnity claims allowed in section 1a. This represents all claims approved for benefits within the reporting year.
3. In section 1b, specify the total number of weeks for which indemnity benefits were paid during the reporting period. Ensure that this figure reflects only the weeks actually covered.
4. Enter the total amount of indemnity paid in section 1c. This should include all benefit payments made within the year.
5. For section 1d, report the amount spent on hospital, surgical, and medical care plan benefits. This figure should represent only the payments made for health services related to claims during the year.
6. Calculate the total benefits paid (1c plus 1d) and enter this amount in section 1e, providing a comprehensive view of all benefit expenditures.
7. Move to section 2, where you will need to report on employees and covered payrolls. In section 2a, indicate the number of employees from whom contributions were deducted.
8. In section 2b, list the number of employees from whom contributions were not deducted. This reflects those exempt from contributions.
9. Add the figures from 2a and 2b to get the total number of covered employees in section 2c. This number is critical for understanding your coverage base.
10. For section 2d, report the covered payrolls. This should be calculated based on a specified period's total earnings, rounded to the nearest hundred dollars.
11. Finally, in section 2e, record the total amount of premiums collected for Disability Benefits policies throughout the calendar year.
12. Proceed to section 3 if necessary, which concerns disabilities related to pregnancy. Complete it with similar attention to detail regarding claims and benefits as required.
13. Once all sections of the form are accurately completed, review the information for any errors before finalizing.
14. You can then save any changes made, download the completed form, print it for your records, or share it as needed.

Take action and complete your NY DB-680 online today to ensure compliance and accurate reporting.