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How to use or fill out CE-200 (exemption form) - Workers' Compensation Board - NY
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Claim Information section. Enter the Date of Injury/Illness and WCB Case #, ensuring all communication includes these numbers.
- In the Injured Worker Information section, provide your Last Name, First Name, Mailing Address, City, State, Zip Code, Daytime Phone #, Email Address, Social Security #, Date of Birth, and Gender.
- Complete the Employer Information section with your Employer's Name and Mailing Address. Specify whether the Tax ID # is an SSN or EIN.
- In the Reason for this Request section, check all applicable boxes and attach any required documents as indicated. Be sure to include additional information if necessary.
- Finally, sign and date the form at the bottom before submitting it via mail or email to the Workers' Compensation Board.
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