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Click ‘Get Form’ to open the NY Citizenship form in the editor.
Begin by entering your Claimant's Name in the designated field. Ensure that the name matches your official documents for accuracy.
Next, input your WCB Case Number. This number is crucial for tracking your request and should be readily available from previous correspondence.
Provide your Social Security or Tax Identification Number along with the Date of Accident. This information helps verify your identity and expedite processing.
If you are authorizing release for additional case files, identify them by their respective WCB/DB/DC/PFL Case Numbers and/or Dates of Accidents in the specified section.
Complete the authorization section by filling in the name and address of the person or entity to whom records will be disclosed.
Finally, sign and date the form using blue ink if possible, ensuring all fields are completed to avoid delays in processing.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (81 Votes)
2007	4.4 Satisfied (92 Votes)

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