NY DB-802 2004 free printable template
Show details
2. Mail the form for filing in duplicate to PLANS ACCEPTANCE UNIT 100 BROADWAY-MENANDS ALBANY NY. 12241-0005 THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION. DB-802 4-04 Reverse www. 3. That the Plan Benefits will be continued until the Employer has filed written notice with the Chair of the termination of the Plan. Employer Date Signed Signature of Owner Partner or Authorized Officer Telephone No. DB-802 4-04 Title Continued on reverse CERTIFICATION BY...
pdfFiller is not affiliated with any government organization
Get, Create, Make and Sign NY DB-802
Edit your NY DB-802 form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your NY DB-802 form via URL. You can also download, print, or export forms to your preferred cloud storage service.
Editing NY DB-802 online
To use the professional PDF editor, follow these steps:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit NY DB-802. Rearrange and rotate pages, add new and changed texts, add new objects, and use other useful tools. When you're done, click Done. You can use the Documents tab to merge, split, lock, or unlock your files.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
pdfFiller makes working with documents easier than you could ever imagine. Register for an account and see for yourself!
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
NY DB-802 Form Versions
Version
Form Popularity
Fillable & printabley
How to fill out NY DB-802
How to fill out NY DB-802
01
Obtain the NY DB-802 form from the New York State Workers' Compensation Board website or your employer.
02
Start by filling in your personal information, including your name, address, and contact details at the top of the form.
03
Provide details about the injury or illness, including the date it occurred and a brief description.
04
Indicate your employment information, including your job title and the name of your employer.
05
Complete any additional sections related to medical treatment, including names of healthcare providers and dates of visits.
06
Review the form for accuracy and completeness before signing.
07
Submit the completed form to your employer or the appropriate workers' compensation insurance carrier.
Who needs NY DB-802?
01
Workers who have suffered a work-related injury or illness.
02
Employees seeking benefits through New York's workers' compensation system.
03
Individuals looking to report their injury or illness for compensation claims.
Fill
form
: Try Risk Free
People Also Ask about
What is the difference between workers comp and disability in NY?
Disability wage payments are 1/2 of a claimant's average weekly wage, up to a set maximum. Workers' Compensation benefits are 2/3 of your weekly salary up to a set maximum. Disability payments are limited to 26 weeks. Workers' Compensation payments continue for the duration of the illness/injury.
Is NYS disability and workers comp the same?
Please note: New York State statutory disability benefits (DB) insurance coverage is totally different from and is not included in New York State workers' compensation insurance coverage.
How do I file a DBL claim in NY?
To file an NY DBL/PFL disability claim, call (866) 274-9887.
What is the maximum New York State disability payment?
Disability benefits are equal to 50 percent of the employee's average weekly wage for the last eight weeks worked, with a maximum benefit of $170 per week (WCL §204). If counting the last week in which the disability began lowers the benefit rate, it is not included in determining average weekly wage.
Can you collect NYS disability and workers comp at the same time?
In short, yes, it is possible to receive workers' compensation benefits and Social Security Disability (SSD) benefits at the same time. To do so, you will need to qualify for both. You should also understand that receiving SSD benefits may affect how much you can collect from your workers' compensation claim.
Who qualifies for short term disability in NY?
Voluntary Short Term Disability You can receive income replacement benefits for up to 26 weeks. An employee working at least 50 percent of full time on a regular appointment and whose annual salary is at least $15,000 is eligible to enroll in the plan.
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
How can I edit NY DB-802 from Google Drive?
Using pdfFiller with Google Docs allows you to create, amend, and sign documents straight from your Google Drive. The add-on turns your NY DB-802 into a dynamic fillable form that you can manage and eSign from anywhere.
How do I make edits in NY DB-802 without leaving Chrome?
Install the pdfFiller Google Chrome Extension in your web browser to begin editing NY DB-802 and other documents right from a Google search page. When you examine your documents in Chrome, you may make changes to them. With pdfFiller, you can create fillable documents and update existing PDFs from any internet-connected device.
How do I fill out NY DB-802 using my mobile device?
You can quickly make and fill out legal forms with the help of the pdfFiller app on your phone. Complete and sign NY DB-802 and other documents on your mobile device using the application. If you want to learn more about how the PDF editor works, go to pdfFiller.com.
What is NY DB-802?
NY DB-802 is a form used in New York State for reporting information related to benefits provided to employees who are entitled to paid family leave.
Who is required to file NY DB-802?
Employers in New York State who provide paid family leave benefits to their employees are required to file NY DB-802.
How to fill out NY DB-802?
To fill out NY DB-802, employers should provide detailed information about the employee, the benefits provided, and any relevant dates, ensuring all sections of the form are correctly completed.
What is the purpose of NY DB-802?
The purpose of NY DB-802 is to report the payment of paid family leave benefits to the state, in order to comply with New York's Paid Family Leave Law.
What information must be reported on NY DB-802?
NY DB-802 requires reporting employee identification information, details about the paid family leave benefits provided, including amounts and dates, and any applicable employer and insurance carrier details.
Fill out your NY DB-802 online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
NY DB-802 is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
