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NEW YORK STATE EMPLOYEE INJURY REPORT This is an Interactive Document. You may fill out online and print as many copies as needed. The injured person must complete Part 1 (below) and Part 3 (on reverse
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Gather necessary information: Begin by collecting all personal and employment details required to complete the form. This includes your name, address, Social Security number, employment history, and payroll information.
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Obtain the correct form: Visit the official website of the New York State government or the appropriate department to download the required employee form. Ensure that you have the most up-to-date version to avoid any discrepancies.
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Read the instructions: Before filling out the form, carefully read the instructions provided. This will help you understand each section and ensure accurate completion.
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Provide personal information: Start by providing your full name, current address, contact information, and Social Security number. This information is crucial for identification and record-keeping purposes.
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Include employment details: Enter your job title, department, and any other relevant employment information as required. You may also need to provide your supervisor's name and contact details.
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Fill out payroll information: Include details related to your salary, payment schedule, deductions, and tax withholding preferences. Ensure accuracy to avoid any issues with your payroll processing.
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Who needs New York State employee?

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Individuals seeking employment with the New York State government or its affiliated departments and agencies.
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Current New York State government employees applying for a new position within the system.
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Employers within the state of New York who are required to maintain proper employee documentation as per legal regulations.
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New York State employee refers to any individual employed by the state of New York.
Employers in New York State are required to file information about their employees.
New York State employee forms can be filled out online or submitted through mail.
The purpose of New York State employee form is to report information about employees for tax purposes.
Information such as employee wages, taxes withheld, and other relevant details must be reported on New York State employee forms.
The penalty for late filing of New York State employee forms can vary, but may include fines and interest on unpaid taxes.
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