Nys wcb exemption 2026

1. Click ‘Get Form’ to open the NYS WCB Exemption form in the editor.
2. Begin by entering your Social Security Number in the designated field at the top of the form.
3. In the next section, print your full name clearly. This is essential for identification purposes.
4. Fill in your residential address accurately to ensure proper communication regarding your exemption status.
5. Next, provide the name of your employer and their place of employment. This information links your exemption claim to your current job.
6. Indicate that you are receiving or entitled to receive primary old-age insurance benefits under Title Two of the Social Security Act by checking the appropriate box or writing a brief statement if required.
7. Sign and date the form at the bottom, ensuring that you do this in front of a notary public as required.
8. Finally, follow the instructions to mail one notarized copy to the Workers' Compensation Board and file another with your employer.

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