Nys disability application 2026

1. Click ‘Get Form’ to open the New York State Disability Benefit Claim form in our editor.
2. 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.
3. In section 6, describe your disability clearly. If it’s an injury, include how, when, and where it occurred.
4. Complete the employment history in section 8. List all employers from the last eight weeks and provide their contact details.
5. 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.
6. Ensure that your healthcare provider completes PART B – HEALTH CARE PROVIDER’S STATEMENT before submitting the form.
7. Finally, send the completed application to The Standard Life Insurance Company of New York as instructed.

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