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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 may also fill this form out online at ...
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 *
Completed and notarized Form C-32.1 must be filed along with Form C-32, Section 32 Agreement.
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:
File a C-3 employee claim form online, complete as many fields with as much detail as you can and submit. No other documents are necessary to file a C-3 and you don’t need to establish an account with the Workers’ Compensation Board. Gather all necessary information.
