Db681 2025

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The document is a Self-Insurer Annual Report for Disability and Paid Family Leave Benefits Law, requiring employers to provide information about eligible employees, payroll, corporate structure changes, claims administration, and contact details. It must be completed by an authorized official and notarized before submission to the New York Workers' Compensation Board.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (32 Votes)
2012	4.4 Satisfied (556 Votes)

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