Db681 2026

1. Click ‘Get Form’ to open the db681 in the editor.
2. Begin by entering your Employer name and address at the top of the form. Ensure you include your full legal name, including designations like 'Inc.' or 'LLC'.
3. In the first chart, input the number of eligible New York employees covered by self-insurance and their corresponding payroll amounts for both Disability Benefits and Paid Family Leave Benefits.
4. For Corporate Structure/Ownership Update, indicate if there have been any changes since your last report by checking 'Yes' or 'No'. If applicable, attach necessary documents.
5. Fill in the primary contact information for Disability Benefits and Paid Family Leave, ensuring all fields are completed accurately.
6. Complete the Claims Administration section by selecting whether you self-administer or use a licensed claims administrator for benefits.
7. Finally, ensure that an Authorized Official signs the report and that it is notarized before submission.

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