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Get Ny Is-1 2013-2026

SICIANS Designation as an Impartial Specialist is for a five (5) year term. Complete both sides of this application. All entries are to be typewritten or printed clearly. Return the completed form to the Workers' Compensation Board, Medical Director's Office, Riverview Center, 150 Broadway - Suite 195, Menands, NY 12204. If you have any questions regarding the completion of this form, you may contact us at the above noted address or call 1-800-781-2362. A physician seeking designation as an Impa.

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How to fill out the NY IS-1 online

Completing the NY IS-1 form is an essential step for physicians seeking designation as an Impartial Specialist in New York State. This guide provides clear instructions to help users fill out the form accurately and efficiently.

Follow the steps to complete the NY IS-1 form online

  1. Click 'Get Form' button to access the NY IS-1 form and open it in your preferred online editor.
  2. Begin by entering your full name, including your first name, last name, and middle initial, as well as your medical degree (e.g., MD, DO).
  3. Provide your New York State medical license number, date of birth, year granted, and registration expiration date. Ensure all information is accurate and clearly presented.
  4. List your most recent board certifications, including specialties and their respective expiration dates. Make sure to include multiple specialties if applicable.
  5. Detail your years of practice in each specialty, indicating the duration clearly for each one.
  6. Identify your office locations in New York State. Include the primary office address and phone number. If needed, attach an additional sheet for more locations.
  7. Enter your tax identification number, and indicate whether you have an active clinical medical practice. If yes, specify the number of hours per week devoted to patient care.
  8. Answer questions regarding past authorizations under the Workers' Compensation Law and detail any relevant information as required.
  9. Describe any employment relationships with health provider organizations or insurance carriers, including any contracts with independent medical examination (IME) entities.
  10. Confirm completion of Continuing Medical Education (CME) courses relevant to workers' compensation practices. Attach necessary certificates if you answered 'yes'.
  11. Address questions about past professional license issues, investigations, or disciplinary actions, providing details as required.
  12. Indicate your availability to testify, providing specifics if necessary, and ensure you agree to the terms outlined in the application.
  13. Sign and date the application to affirm that your answers are true. Review all entries for accuracy before submitting.

Complete the NY IS-1 form online today to ensure your designation as an Impartial Specialist.

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New York was the 11th state to ratify the U.S. Constitution on July 26, 1788. The state's unique history and role as a major center for commerce and culture make it an essential part of America's development. As such, knowing New York's historical significance can enhance your understanding of both its current status and ongoing real estate opportunities in the region.

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Determining how many allowances to claim on your NY IS-1 form requires careful consideration of your employment status, tax liabilities, and family situation. Generally, the more allowances you claim, the less tax will be withheld from your paycheck. However, a higher number of allowances could lead to a tax bill at the end of the year if not correctly calculated. Platforms like USLegalForms can assist you in understanding and optimizing your allowance claims.

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