Nys compensation death benefits 2026

1. Click ‘Get Form’ to open the NYS Compensation Death Benefits affidavit in the editor.
2. Complete Section A by providing your name as the claimant and the decedent's details. Ensure you include the decedent’s Social Security number on each page.
3. Fill out Section B, which requires notarization. This is essential for validating your affidavit.
4. Depending on your relationship to the decedent, complete the relevant sections (e.g., Section 2 for spouses, Section 3 for children). Only fill out sections that apply to you and strike out any that do not.
5. Attach necessary documents such as death certificates and proof of relationship. Ensure all information is accurate and legible before submission.
6. Once completed, mail the notarized affidavit along with all attachments to the Workers’ Compensation Board at the specified address.

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