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Workers Compensation / Disability Insurance
C) Form DB-155, Certificate of Disability Benefits Self-Insurance. The Contractor must call the Boards Self-Insurance Office at 518-402-0247 to obtain this
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DDX155 DDX1035 DDX1035M
*2 DDX155 only. Installation Procedure. 1 To prevent a short circuit, remove the key from the ignition and disconnect the .
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Disability Benefits Forms Insurers and Self-Insured Employers
Forms DB-120, DB-120.1 and DB-155 are not available on this site. Insurance carriers, their licensed agents, and self-insured employers may email the Board
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