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Instructions for Completing Employee Claim (Form C-3) Please complete this form and send it to the Workers' Compensation Board centralized mailing address listed at the end of these instructions. If you need additional help completing this form, contact the Workers' Compensation Board at 1-877-632-4996. You
If you need additional help in completing this form, contact the Workers' Compensation Board at 1-877-632-4996. You may also fill this form out online at http://www.wcb.ny.gov/
Completed and notarized Form C-32.1 must be filed along with Form C-32, Section 32 Agreement.
Download the Employee Claim (Form C-3) Complete Form C-3 and print it. Paper forms may be mailed to The Board (or emailed as a digital file). OR. IN PERSON: If you do not have access to a computer, visit the nearest Workers' Compensation Board Office to file a claim.
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. Type print neatly. This form may also be filled out on-line at www.wcb.ny.gov. WCB Case Number (if you know it): C-3 or. A. YOUR INFORMATION (Employee) 1. Name: First. MI.
Please complete this form and send it to the Workers' Compensation Board centralized mailing address listed at the end of these instructions. If you need additional help completing this form, contact the Workers' Compensation Board at 1-877-632-4996. You may also fill this form out online at wcb.ny.gov.
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. Type print neatly. This form may also be filled out on-line at www.wcb.state.ny.us. WCB Case Number (if you know it): C-3 or. A. YOUR INFORMATION (Employee) 1. Name:
