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Product Manufacturer SKU More Info
New York Affidavit for Death Benefits StateFP FFNY150
New York Affidavit for Death Benefits (Dependent Brothers/Sisters/Grandchildren), AFF-2 (2/04) StateFP FFNY205
New York Affidavit for Death Benefits (Dependent Parents/Grandparents), AFF-3 (2/04) StateFP FFNY210
New York Affidavit for Death Benefits (dependents) StateFP FFNY155
New York Affidavit For New York Entities With No Employees And Certain Out Of State Entities WC/DB-100 (9/07) StateFP FFNY035
New York Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance, BP-1 (9/07) StateFP FFNY215
New York Alternative Dispute Resolution Program Final Disposition or Settlement of Claim ADR-2 (8/03) StateFP FFNY615
New York Alternative Dispute Resolution Program Report of Injury ADR-1 (11/06) StateFP FFNY605
New York Alternative Dispute Resolution Program. Modification of Previous Report ADR-1.1 (1/08) StateFP FFNY610
New York Application for Acceptance of Insurance Form DB-850 (3/02) StateFP FFNY865
New York Application for Advance on Periodic Payments of Compensation C-21 (2/04) StateFP FFNY250
New York Application for Approval of Non-Schedule Adjustment C-22 (2/04) StateFP FFNY255
New York Application for Reopening of Claim, More Than Seven Years After Accident C-25 (8/03) StateFP FFNY260
New York Attending Doctor's Report, C-4 (7/07) StateFP FFNY235
New York Attending Doctor's Request for Medical Authorization Determination MD-1 (7/07) StateFP FFNY360
New York Attending Opthamologist's Report, C-5 (7/07) StateFP FFNY245
New York Attending Psychologist's Report, PS-4 (7/07) StateFP FFNY400
New York Attorney/Representative's Application for Fee OC-400.1 (11/06) StateFP FFNY385
New York Authorization for claimants to allow access to records before the Board (Spanish) OC-110AS StateFP FFNY375
New York Biannual Recertification to Entitlement to Benefits DD-2 (9/05) StateFP FFNY320
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