NY WCB C-3 2011 free printable template

C-3 Employee Claim State of New York - Workers Compensation Board Fill out this form to apply for workers compensation benefits because of a work injury or work-related illness. If you were treated by a doctor indicate the name s and address es of the doctor s whom provided care and complete and file Form C-3. Do you remember having another injury to the same body part or a similar illness If yes provide the names and addresses of the doctor s who treated If yes were you treated by a doctor...

How to fill out NY WCB C-3

How to fill out NY WCB C-3

1. Obtain the NY WCB C-3 form from the New York State Workers' Compensation Board website or your employer.
2. Fill in your personal information including your name, address, and social security number.
3. Provide details about your employer, including the company name and address.
4. Describe the accident or illness, including the date it occurred and how it happened.
5. Document any medical treatment you received as a result of the injury.
6. Sign and date the form at the bottom.
7. Submit the completed form to your employer and ensure that a copy is sent to the Workers' Compensation Board.

Who needs NY WCB C-3?

1. Workers who have experienced a work-related injury or illness and need to file a claim for workers' compensation benefits.

Instructions and Help about NY WCB C-3

Hey folks this is Steve with nonprofit ally, and today I'm going to be going over the 501c3 application for nonprofits its form 10:23 that's one zero to three that you'll be filling out and submitting to the IRS I'm going to go over the application that I'm actually submitting to them for Noble pause which is a non-profit that we're starting up here in Alaska, and I'll take you through the different sections of the 501c3 application the form 10:23 and give you an idea of what to expect when you're going to go ahead and fill out this form there's a number of things you have to have in place prior to filling out your form 10:23, and I'll go over what those things are, so you can be prepared when you do fill out this form so if you're ready let's go ahead and get started all right, so this is the IRS 10:23 application it's laid out for you here, and I'm going to just give you a quick overview of this because I'm going to go into a little more detail just following this so the first thing you're going to have is the 10:23 checklist and that is actually included in part of the application and needs to be turned in then there is your 10:23 application which is about 14 pages long after that yet turn in your articles of organization which you should have already filed with your state if you've done any amendments to your articles of organization or your Articles of Incorporation as some people called it if there are any amendments be sure to include those and then of course you have to include your bylaws which should have already been approved at your first nonprofit meeting so all of this should already be completed at this point and then here are all the attachments that go along with your 10:23 application and each attachment is for different sections that throughout the application process that you have to fill in with more details, so those attachments get included and of course you have to pay the IRS for this and currently at the time of this recording its eight hundred and fifty dollars to apply for your 501c3 status, and you do need an EIN number, so it's easy it's free you know it takes five minutes to fill out, and you can do it online just look up EAN and IRS and E I n and Google, and it'll get you to the right page okay so let's head on into the more detailed version of this okay folks were there she is this is your form 10:23 that you can download from the IRS is website it's a PDF file I'm going to flip through this for you, so we're going to just going to remove it here, and we'll kind of just go through it quickly page by page, so you can get an idea of what you're what you're in for here a lot of it has checkboxes that you can fill out on your own as you go through it other with other times you can type in your information right into the lines but what's going to end up happening is you go through if it's going to ask you to attach files and documents to it so that you can explain more in detail some of the questions they're asking...

People Also Ask about

What is the New York Workers Compensation Benefit?

Compensation Rates An injured employee is entitled to a compensation rate equal to two-thirds of the average weekly wage (AWW) in New York State for the 52-week period immediately prior to the date of accident. The rate is subject to prescribed maximums and degree of disability.

How long do you have to file a workers comp claim in NYS?

When to File. You must notify your employer within 30 days, but it is best to do so as soon as possible. If 30 days pass and you have not notified your employer, you may lose your rights to workers' compensation benefits.

What is the statute of limitations for workers comp claims in NY?

New York law states that workers have up to two years to file a claim if they are suffering from a work-related illness or injury. For occupational hearing loss, workers have up to three months to report the injury and 90 days to file a workers' compensation claim.

How do I file a workers comp claim in NYC?

Call: 866-396-8314. A Board representative will take your information and complete the C-3 form. Submit a paper C-3 form.

How long does an employer have to file a workers comp claim New York?

Your employer must notify their insurance carrier within 10 days of the injury or illness if you require medical treatment beyond first aid or have lost at least one day from work other than the date the injury or illness occurred.

How do I check the status of my workers compensation claim in NY?

If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.

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What is NY WCB C-3?

NY WCB C-3 is a form used to report an employee's injury or illness to the New York State Workers' Compensation Board.

Who is required to file NY WCB C-3?

Employers are required to file the NY WCB C-3 form when an employee is injured or becomes ill as a result of their work.

How to fill out NY WCB C-3?

The NY WCB C-3 form must be filled out by providing details about the employee, the nature of the injury or illness, and other relevant information such as the date and location of the incident.

What is the purpose of NY WCB C-3?

The purpose of the NY WCB C-3 form is to officially notify the Workers' Compensation Board about a work-related injury or illness for the purpose of initiating a claim.

What information must be reported on NY WCB C-3?

The NY WCB C-3 form must report information such as the employee's personal details, the date and circumstances of the injury or illness, medical treatment details, and any witnesses to the incident.