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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
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 *
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. You may also fill this form out online at http://www.wcb.ny.gov/
Download Fillable Form C-3 In Pdf - The Latest Version Applicable For 2024. Fill Out The Employee Claim - New York Online And Print It Out For Free. Form C-3 Is Often Used In New York State Workers' Compensation Board, New York Legal Forms, Legal And United States Legal Forms.
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.
WCB Case Number (if you know it): Fill out this form to apply for workers' compensation benefits because of a work injury or work-related illness. Type or print neatly. This form may also be filled out on-line at www.wcb.ny.gov.
01. Obtain the NY Workers Compensation C form from your employer or the New York State Workers' Compensation Board website. 02. Fill in your personal information, including your name, address, and contact information. 03. Provide details about your employer, including their name, address, and contact information. 04.
