NY DB-130 2019-2025 free printable template
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Employee\'s Statement of Exempt Status
Workers\' Compensation Board, Disability Benefits Bureau, PO Box 9029, Endicott, NY 137619029
Annually, eligible employees must reaffirm the Employee\'s Statement
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How to fill out NY DB-130
01
Obtain the NY DB-130 form from the New York State Unified Court System website or local courthouse.
02
Carefully read the instructions provided at the top of the form.
03
Fill in your name and the names of all parties involved in the case in the designated sections.
04
Provide the court's information, including the index number and the court's address.
05
Specify the nature of the relief you are seeking in the case.
06
Include any supporting documents that are necessary for your claim.
07
Review the completed form for any errors or omissions.
08
Sign and date the form in the designated area at the bottom.
Who needs NY DB-130?
01
Individuals involved in a divorce or child custody case in New York City who need to request a default judgment or other relief.
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What is NY DB-130?
NY DB-130 is a form used in New York State to report and document claims for disability benefits under the Disability Benefits Law.
Who is required to file NY DB-130?
Employers in New York State who provide short-term disability insurance for their employees are required to file NY DB-130.
How to fill out NY DB-130?
To fill out NY DB-130, provide the necessary employee information, including personal details, dates of disability, and relevant medical information. Make sure to follow the instructions on the form carefully.
What is the purpose of NY DB-130?
The purpose of NY DB-130 is to formally notify the New York State Workers' Compensation Board about an employee's claim for disability benefits and to facilitate the processing of those claims.
What information must be reported on NY DB-130?
The information that must be reported on NY DB-130 includes the employee's personal details, the employer's information, the nature and duration of the disability, and any medical or treatment details relevant to the claim.
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