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2. wcb.ny.gov › content › mainEmployers Workers' Compensation Forms

   wcb.ny.gov › content › main

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   Commonly Used Forms available for printing and mailing to the Workers' Compensation Board

   • Common Board Forms

     Workers' Compensation Board, copies to workers' compensation...

   • Ce-200

     A Certificate of Attestation of Exemption (CE-200) can only...

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     Commonly Used Forms available for printing and mailing to...

3. People also ask

   How do I submit a workers' compensation form?

   • This form may be submitted in person at any Board office, mailed or faxed ( (877) 533-0337) to the Board. Workers' Compensation Board, copy to all claimant's health providers, copy to insurance carrier/self-insured employer. Immediately upon being retained. An R number is required. The Board will only accept the current version of this form.

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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   How do I request disclosure of my Workers' Compensation Records?

   • Claimants looking to authorize disclosure of their Workers’ Compensation Records should use the OC-110a form. Give the completed form to your doctor, who will keep it with your records. THIS FORM SHOULD NOT BE FILED WITH THE WORKERS' COMPENSATION BOARD. As of 3/7/22, this is no longer a paper form and all requests are to be submitted via OnBoard.

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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   When can I file a workers' compensation form?

   • The Board will only accept the current version of this form. Workers' Compensation Board, with copies to claimant and claimant's representative, if any. The form may be filed at any time after the assembly or indexing of a claim or after the Board has indicated that no further action (NFA) will be taken.

   Workers' Compensation Board All Common Forms

   wcb.ny.gov/content/main/forms/AllForms.jsp

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   What is a workers' compensation - employee medical & work status form?

   • The Workers' Compensation - Employee Medical & Work Status Form may be used by a physician to report an injured employee’s medical progress and work status to a payor requesting such information. A copy of the completed form must also be provided to the injured employee.

   Workers' Compensation Forms - CT.gov

   portal.ct.gov/wcc/home-forms/workers-compensation-forms

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4. wcb.ny.gov › content › mainWorkers' Compensation Board All Common Forms

   wcb.ny.gov › content › main

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   Workers' Compensation Board, copies to workers' compensation insurer, claimant and claimant's representative. Prior to award of workers' compensation benefits. Carriers and Board-approved Self-Insurers may contact the Board's Forms Department to obtain this form.

   Form Number/ Version Date	Form Title	Who Files	Where To File
   A-9 (11/21)	Notice that You May Be Responsible for ...	Employee	File with Health Provider
   ADR-1 (6/22)	Alternative Dispute Resolution Program ...	Employers Participating in the ...	Workers' Compensation Board
   ADR-1.1 (1/11)	Alternative Dispute Resolution Program: ...	Employers Participating in the ...	Workers' Compensation Board
   ADR-2 (1/11)	Alternative Dispute Resolution Program ...	Employers Participating in the ...	Workers' Compensation Board

   See full list on wcb.ny.gov

5. www.dol.gov › general › formsForms | U.S. Department of Labor

   www.dol.gov › general › forms

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   LS-801 (Form Name - Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)

6. wcb.ny.gov › content › mainWorkers' Compensation Board Common Forms

   wcb.ny.gov › content › main

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   Commonly Used Forms available for printing and mailing to the Workers' Compensation Board.

7. www.dol.gov › sites › dolgovls-202 - Employer's First Report of Injury or Occupational ...

   www.dol.gov › sites › dolgov

   This report is required by 33 U.S.C. 930(a) and must be filed with the U.S. Department of Labor, Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation by electronic submission via OWCP web portal, facsimile or Central Mail Receipt Site.

   • File Size: 267KB

   • Page Count: 2

8. portal.ct.gov › workers-compensation-formsWorkers' Compensation Forms - CT.gov

   portal.ct.gov › workers-compensation-forms

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   Jul 13, 2009 · The Employer's First Report of Occupational Injury or Illness form is to be completed by an employer or its workers' compensation insurance carrier to notify the Workers' Compensation Commission of occupational injuries or illnesses that result in incapacity for one day or more.

9. www.dir.ca.gov › dwc › formsDWC Forms - California Department of Industrial Relations

   www.dir.ca.gov › dwc › forms

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   DWC Forms. Forms are grouped by relevant subject, then in alphabetical order. Use the arrows to change to reverse alphabetical order or search by form number. The ten most-downloaded forms also appear in the “ Frequently used forms ” section. Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form.