Db 450 Form Part C For 2018

State:
New York
Control #:
NY-DB-450-WC
Format:
PDF
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Description

This is one of the official workers' compensation forms for the state of New York.

How to fill out New York Notice And Proof Of Claim For Disability Benefits?

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FAQ

If you are using this form because you became disabled after having been unemployed for more than four (4) weeks, your completed claim MUST be mailed to: Workers' Compensation Board, Disability Benefits Bureau, PO Box 9029, Endicott, NY 13761-9029.

File a Claim for Disability Benefits If so, please complete NYSIF Form DB-450 and submit your claim to NYSIF. Use this form if you become sick or disabled while employed or if you become sick or disabled within four weeks after your last day worked.

Apply by phone: Call SSA at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. Apply in person: Visit your local Social Security office. (Call first to make an appointment.)

Short Term Disability - NYS You must first exhaust any sick leave benefits. After a seven-calendar-day waiting period, you receive 50 percent of your average salary for the eight weeks prior to disability, up to the maximum benefit established under the New York State Disability Benefits Law, currently $170 per week.

If you are unemployed and have been collecting unemployment benefits for longer than four weeks at the time you become disabled, you will file a DB-300 form. These forms can be obtained on the NYSIF website, from your local Workers' Compensation Board, or by calling 800-353-3092.

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Db 450 Form Part C For 2018