To Self-Insurers Providing Benefits 2026

1. Click ‘Get Form’ to open the To Self-Insurers Providing Benefits document in the editor.
2. Begin by filling out the required information regarding claims, benefits, employee contributions, and covered payrolls as specified in Item 1(a). Ensure that you report this data accurately on form DB-681 before the January 31 deadline.
3. In Item 2e, report only the first $7,000 of earnings for each employee paid during the calendar year. This is crucial for compliance with self-insurance regulations.
4. Complete the list of office and plant locations in New York State as outlined in Item 2d. Include addresses and number of employees at each location, marking those where disability benefits claims are maintained.
5. If applicable, prepare a report of excess employee contributions using form DB-681.1. Remember that this step does not apply to certain associations or union welfare funds.

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