NY DB-150 2017-2026 free printable template
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APPLICATION FOR SELFINSURANCEDISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
Email completed form to: selfinsurance@wcb.ny.gov
An employer may apply for self insurance for disability benefits or for
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How to fill out NY DB-150
01
Download the NY DB-150 form from the New York Department of Labor website.
02
Read the instructions carefully before filling out the form.
03
Enter your personal information in the appropriate fields, including your name, address, and Social Security number.
04
Indicate your employment status and the reason for filing the application.
05
Provide details about your last employer, including company name, contact information, and employment dates.
06
Include any additional information requested, such as your work history and any relevant claims.
07
Review the completed form for accuracy and completeness.
08
Sign and date the form at the designated section.
09
Submit the form according to the instructions provided, either online or by mail.
Who needs NY DB-150?
01
Individuals who have been separated from their employment and are seeking unemployment benefits in New York.
02
Workers who need to report information related to their unemployment claims.
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What is NY DB-150?
NY DB-150 is a form used in New York for filing an Unemployment Insurance claim for federal benefits under the Defense Base Act.
Who is required to file NY DB-150?
Employers in New York who have employees engaged in work on federal contracts or subcontracts overseas, and who are subject to the Defense Base Act, are required to file NY DB-150.
How to fill out NY DB-150?
To fill out NY DB-150, you need to provide information about the employer, employee, and the nature of the employment, along with the required details such as wages and employment duration.
What is the purpose of NY DB-150?
The purpose of NY DB-150 is to serve as documentation for employers to report information regarding employees who may be eligible for benefits under the Defense Base Act.
What information must be reported on NY DB-150?
The information that must be reported on NY DB-150 includes details about the employer, employee personal information, job description, wages, and work duration.
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