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Nys disability application 2026
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- Click ‘Get Form’ to open the New York State Disability Benefit Claim form in our editor.
- Begin with PART A – CLAIMANT’S STATEMENT. Fill in your personal details, including your name, address, and date of birth. Ensure all information is accurate.
- In section 6, describe your disability clearly. If it’s an injury, include how, when, and where it occurred.
- Complete the employment history in section 8. List all employers from the last eight weeks and provide their contact details.
- Once you’ve filled out PART A, sign and date the form at section 12. If you need assistance, a representative can sign on your behalf.
- Ensure that your healthcare provider completes PART B – HEALTH CARE PROVIDER’S STATEMENT before submitting the form.
- Finally, send the completed application to The Standard Life Insurance Company of New York as instructed.
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new york state disability form
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