Coverage disability form printable 2025

1. Click ‘Get Form’ to open the coverage disability form printable in the editor.
2. Begin by entering the employer's name and the name under which the business is conducted in the designated fields.
3. Fill in the address and telephone number, ensuring all contact information is accurate for future correspondence.
4. Provide your Federal Employer's Identification Number or Social Security Number if you are a sole proprietor, along with your U.I. Employer Registration Number.
5. Indicate the total number of employees and specify how many employees fall under classes not required by law for disability benefits.
6. In section A, confirm whether you are a covered employer as defined by New York State Disability Benefits Law.
7. Complete sections B and C regarding benefits to be provided and methods of providing those benefits, selecting options that apply to your situation.
8. Ensure that you certify employee agreement on contributions and provide necessary signatures at the end of the form.

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