If you require assistance with completing these forms, please contact your local WCB District Office.
| Form Number / Version Date |
Form Title | Who Files | Where to File | When to File |
|---|---|---|---|---|
| CE-200 (12/08) | Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage | Applicants for permits, licenses or contracts from State, county or municipal agencies in New York State that are not required to carry NYS workers' compensation and/or disability benefits insurance coverage. | Please file with the government agency that is issuing the permit, license or contract. (Examples: The New York City Department of Buildings or the New York State Department of Health) | These exemption forms can ONLY be used to attest to a government entity that an applicant requesting a permit, license or contract from that government entity is not required to carry NYS workers' compensation and/or disability benefits insurance. (Instructions) |
| DB-120.1 (10/17) | Certificate of Insurance Coverage under the NYS Disability and Paid Family Leave Benefits Law | Employers | Filed with any entity requesting to be a certificate holder including a government agency issuing a permit, license or contract. The DB-120.1 must be completed by either the NYS statutory disability benefits insurance carrier, or a licensed NYS insurance agent of that carrier. | Employers must obtain this form from either their NYS statutory disability benefits insurance carrier or a licensed NYS insurance agent of that carrier. Carriers, their licensed agents, and Self-Insured Employers may email the Board at Certificates@wcb.ny.gov to obtain controlled forms not available on this website. |
If the form you are looking for is not listed above, or in the list of Common Board Forms, please e-mail the Board's Forms Department.
