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New York Workers Compensation Forms

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Welcome to our New York forms and guide page.  We make every effort to provide you with free and direct access to the most common forms and guides related to New York workers comp coverage.  We update our forms regularly so you have the most recent forms available.  Please contact us if you have a question or need help with a particular New York comp form.

New York State Workers' Compensation Board is responsible for administering the NY work comp program under the direction of the New York Department of Insurance.  NY is not an NCCI state and, therefore, develops its own unique manuals and rules regarding workers compensation classifications and experience modifications. 

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Questions? Call 888.611.7467 for a Workers Compensation Shop Specialist


 NY Comp Forms


New York Workers Compensation Forms

NY Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in New York.

New York First Report of Injury Form

NY First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

New York Surcharge Descriptions

This document provides detail information regarding workers' compensation in New York.

New York Workers Compensation and Employers Liability Manual

This form details the Assessment charges for New York workers' compensation programs.

Workers' Compensation Employee Claim Form

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

Workers' Compensation Employee Claim Information Packet

This packet contains the application material to file a claim, and provides greater detail about filing a claim.

NY Election to Exclude Spouse

Sole-proprietorships, regular partnerships, individual trustees, individual receivers and legal representatives may be eligible for spousal exemptions. Corporations, LLCs, LLPs, LPs, PLLCs, PLLPs, RLLCs, RLLPs, Joint Ventures, associations, unions, and nonprofits are NOT eligible for spousal exemptions.

New York Workers' Compensation Exemption Form

Use this form if you are not required to carry workers' compensation and/or disability benefits insurance.

New York Rejection of Workers Compensation Coverage Form

Notice of election of a corporation which is required to have coverage for its employees under the New York state workers' compensation law to exclude the sole shareholder-officer or one of the two or both executive officers-shareholders of the corporation from such coverage.

What Employers Need to Know About Workers' Compensation

This is a document containing an overview of information pertaining to New York workers' compensation.

New York Notice to Reduce or Discontinue Payments

Form for the reduction or discontinuation of Workers Compensation in New York.

Voluntary Agreement Form

Employer/Respondents form for confirmation of claim information and verification of the validity of the claim.

New York Notice of Election Form

Notice of election of a partnership, limited liability partnership, professional limited liability partnership, limited liability company, professional limited liability company or sole proprietorship to bring partners, members or self-employed person under the coverage of the New York state workers' compensation law.

New York Workers' Compensation Employer Handbook

A Guide to the Workers’ Compensation and the Disability Benefits Systems for the New York State Business Owner.

Employee Statement of Exempt Status

Complete this form if you are receiving old-age insurance benefits under Section 235 of the Social Security Act.

New York State Resources

New York State Insurance Department

Rockefeller Empire State Plaza
Agency Building One
Albany, NY 12257

New York State Workers’ Compensation Board
20 Park Street
Albany, New York 12207
(877) 632-4996, Fax: (518) 473-1415, Fraud: (888) 363-6001

New York State Insurance Fund
199 Church Street
New York, New York 10007
(888) 875-5790, (212) 312-9000, Fax: (212) 385-2073


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NY Independent Contractors

New York views any worker under your direct control as an employee for work comp purposes.  A worker's tax status does not determine whether or not workers' compensation insurance is required.  Most NY employers may need coverage even for 1099 employees.


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