Last updated on Apr 10, 2026
NY DB-112 free printable template
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What is NY DB-112
The Employer Termination Statement is a legal document used by employers in New York to formally terminate their status as a covered employer under Disability and Paid Family Leave Benefits Law.
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NY DB-112 is needed by:
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Employers in New York terminating benefits
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Business owners ending employee status
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HR managers representing companies
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Authorized officers handling employment records
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Legal representatives coordinating termination procedures
Comprehensive Guide to NY DB-112
What is the Employer Termination Statement?
The Employer Termination Statement is designed for New York employers to formally terminate their status under the Disability and Paid Family Leave Benefits Law. This crucial document requires essential information, including the employer's name, Federal Employer Identification Number (FEIN), and address.
This form serves a specific purpose in the New York regulatory framework, ensuring employers correctly document their termination of benefits. By providing this information, employers can maintain compliance with state requirements and avoid any legal ramifications.
Why Employers Need the Employer Termination Statement
Filing the Employer Termination Statement is vital for employers to meet legal obligations. Properly submitting this form helps employers navigate compliance with state laws and regulations concerning disability benefits and paid family leave.
Failure to file accurately can lead to complications regarding benefits status, making it essential for employers to understand the implications of this termination process.
Key Features of the Employer Termination Statement
The Employer Termination Statement comprises several key components that must be completed accurately. Important fields include:
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Employer's Name
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Employer's FEIN
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Employer's Address
Additionally, the form contains certification statements that require verification by an authorized officer's signature, emphasizing the importance of accurate and truthful representation of the employer's status.
Who Needs the Employer Termination Statement?
This form is necessary for employers who wish to terminate their employer status under the Disability and Paid Family Leave Benefits Law. Scenarios that warrant submission include changes in business structure, such as LLCs or partnerships, or when previous coverage is no longer applicable.
Business owners must assess their current coverage and determine eligibility for completing this form accordingly.
How to Fill Out the Employer Termination Statement Online
Completing the Employer Termination Statement online can streamline the process and reduce errors. Follow these steps to fill out the form:
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Gather necessary information, including the employer's name, FEIN, and address.
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Access the form through pdfFiller's platform.
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Fill in all required fields accurately, paying close attention to certification statements.
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Review the information for any mistakes before submission.
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Submit the completed form electronically or via print.
The digital format provided by pdfFiller helps minimize common errors, making it easier for employers to maintain compliance.
Common Errors and How to Avoid Them
Error prevention is key when filling out the Employer Termination Statement. Common mistakes include:
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Omitting required fields
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Incorrectly entering the FEIN or employer's name
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Failing to obtain the authorized officer's signature
Employers should double-check all submitted information carefully before sending the form to the appropriate department to ensure accuracy and uphold compliance.
Submission Methods and Deadlines for the Employer Termination Statement
Employers have several options for submitting the Employer Termination Statement. Acceptable submission methods include:
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Electronic submission via pdfFiller
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Paper submission through mail
It's crucial to be aware of specific deadlines related to employer status termination to avoid penalties. Properly adhering to these timelines ensures that the employer's status is accurately recorded.
What Happens After You Submit the Employer Termination Statement?
After submission, employers can expect a confirmation of receipt from the Workers' Compensation Board. It is advisable to track the status of the application to safeguard against potential issues.
Employers should also retain records of their submission for any future reference, ensuring they have documentation in case of inquiries or disputes.
Security and Compliance with the Employer Termination Statement
When handling the Employer Termination Statement, maintaining data security is paramount. pdfFiller employs robust encryption protocols and adheres to compliance measures to protect sensitive employer information during the filing process.
Employers must ensure that they manage their data securely while completing any forms, thereby safeguarding against unauthorized access and ensuring compliance with privacy standards.
Why Choose pdfFiller for Your Employer Termination Statement Needs?
pdfFiller offers extensive features that simplify the creation, completion, and submission of forms like the Employer Termination Statement. Users benefit from a cloud-based platform that enables secure document management and easy access from any browser.
With tools designed to minimize errors and ensure compliance, pdfFiller stands out as a reliable option for employers navigating the form-filling process.
How to fill out the NY DB-112
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1.Open your web browser and navigate to pdfFiller's website. Search for 'Employer Termination Statement' using the search bar.
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2.Once located, click on the form to open it in pdfFiller's online editor.
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3.Before filling out the form, ensure you have the necessary information such as the employer's name, FEIN, and address at hand.
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4.Use the form's fillable fields to enter the required details, including 'EMPLOYER'S NAME', 'EMPLOYER'S FEIN', and 'EMPLOYER'S ADDRESS'.
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5.For signatures, locate the field for the 'Signature of Owner, Partner or Authorized Officer' and use the electronic signature feature or take a scanned signature image.
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6.After completing all fields, review the form for accuracy, ensuring all required information is filled out correctly.
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7.Once satisfied, look for the options to save, download, or submit the completed form directly through pdfFiller.
Who is eligible to use the Employer Termination Statement?
Any employer in New York who wishes to terminate their status as a covered employer under the Disability and Paid Family Leave Benefits Law is eligible to use this form.
What is the deadline for submitting the Employer Termination Statement?
While specific deadlines may vary, it is important to submit the form as soon as the decision to terminate status is made to avoid potential liabilities under the law.
How do I submit the Employer Termination Statement?
After completing the form, you can submit it directly through pdfFiller by following the prompts to either email it to the Workers' Compensation Board or download it for mailing.
Are there any supporting documents required when submitting this form?
Typically, no additional documents are required when submitting the Employer Termination Statement, but it’s prudent to keep a record of any related employment documentation.
What common mistakes should I avoid while completing this form?
Ensure all fields are filled out accurately. Common mistakes include omitting required information and failing to provide a signature from an authorized officer.
How long does it take for the termination to be processed?
Processing times can vary, but expect a few weeks for the Workers' Compensation Board to review the termination statement once submitted.
What happens if I don’t submit the form appropriately?
Failing to submit the Employer Termination Statement correctly can result in continued liabilities as a covered employer and potential fines.
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