http://www.wcb.ny.gov/content/main/forms/c2inst.pdf WebForm. Number Workers' compensation claim form. Spanish - Chinese - Korean - Tagalog - Vietnamese; DWC 1: Employer's report of occupational injury or illness: DLSR 5020: Petition for permission to negotiate a section 3201.7 …

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Webpenalties, the C2 form must be submitted six (6) days from the date of injury. Each head of office, or school, should ensure that he/she or a designee submits the C2. To receive access to, or for assistance with submitting, the C2 form, please call the DOE Workers’ Compensation Unit at 718-935-2213. FPC/mw C: M Tragale K Monrose D John WebIf one of your employees has a work-related injury or illness, you must complete and file this form . within 10 days. of the injury/illness or be subject to a penalty. For additional information on filing this form please refer to Workers' Compensation Law Section 110 at the end of this form. Type or print neatly. A. EMPLOYER INFORMATION naturfreak accessories

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WebFile a C-3 employee claim. Or. Call: 866-396-8314. A Board representative will take your information and complete the C-3 form. Submit a paper C-3 form. You can get a paper form from your employer or from the NYS … Webas provided by the FECA or who knowingly accepts compensation to which that person is not entitled is subject to civil or administrative remedies as well as felony criminal prosecution and may, under appropriate criminal provisions, be punished by a fine or imprisonment or both. Form CA-2 Webworkers’ compensation benefits. Use the attached form to file a workers’ compensation claim with your employer. You should read all of the information below. Keep this sheet and all other papers for your records. You may be eligible for some or all of the benefits listed depending on the nature of your claim. If you naturfreibad bad clevers