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Workmens compensation transfer form

New york election sheltered 2026

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The document is a notice from the New York Workers' Compensation Board regarding the election to provide workers' compensation benefits to participants in sheltered workshop programs. It outlines the legal provisions under Section 33.09 of the Mental Hygiene Law, stating that certain agencies can elect to offer these benefits, excluding those under Article Nine of the Workers' Compensation Law. The document includes sections for agency details, participant information, and certification by an authorized person.

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Click ‘Get Form’ to open the New York Election Sheltered document in the editor.
Begin by filling in the name and address of your insurance carrier in the designated fields. Ensure accuracy to avoid any processing delays.
In the section for 'Sheltered Workshop Programs to be Included in Policy', list each program's name and address, along with the number of participants involved. This information is crucial for compliance.
Next, have an authorized person from your office or agency certify the election by entering their name and title. This step confirms that the decision was made at a proper meeting.
Finally, ensure that the signature, telephone number, and date are filled out correctly at the bottom of the form. This validates your submission.

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Specifically, the New York City Human Rights Law prohibits discrimination in housing based on actual or perceived race, creed, color, national origin, gender, age, disability, sexual orientation, uniformed service, marital status, partnership status, alienage or citizenship status of any person or group of persons, or

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