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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.
Employee Claim. EC-3. State of New York - Workers' Compensation Board. THIS FORM MAY ONLY BE SUBMITTED ELECTRONICALLY. DO NOT MAIL. Fill out this form to apply for workers' compensation benefits because of a work injury or work-related illness. Required items are indicated by an * Employee Info. Employer Info. Job Info. Injury or Illness Info.
Instructions for Completing Form C-3, “Employee Claim”. Please complete this form and send it to the Workers' Compensation Board centralized mailing address listed at the bottom of these instructions. If you need additional help in completing this form, contact the Workers' Compensation Board at. 1-877-632-4996.
View, download and print fillable C-3 - Employee Claim - State Of New York - Workers' Compensation Board in PDF format online. Browse 3 Unsorted New York State Workers Compensation Board Forms And Templates collected for any of your needs.
Printing T:\\AAOSHARE\\FINLFORM\\C3.FRP. 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.
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:
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.
