Completing Forms
If you require assistance with completing these forms, please contact us.
Forms are in PDF format. The Board recommends using the latest version of Adobe Reader which is available as a free download from Adobe's website. After the form opens, you may complete the form by typing information on the form before you print it. Please enter your information, select print and choose Microsoft Print to PDF and submit the saved PDF. Please note, that if you do not Print to PDF, the entered data may not be transmitted resulting in a blank form being submitted. If you have trouble opening a form: (1) download/save the form onto your computer, (2) open Adobe Reader, (3) open the saved file. If you still have trouble with the form, please email the Board's Forms Department.
Multi-page Forms
Two-sided and multi-page forms are to be printed and submitted to the Board in duplex format. If this is not possible, submit as separate sheets. However, do NOT submit to the Board any sheets that contain only instructions and/or reference material. Parties of interest other than the Board must receive both sides of all two-sided forms and all pages of multi-page forms.
Current Versions of Forms
WCB periodically releases new versions of certain forms to obtain additional information, streamline processing, and/or make it easier to complete the form. These changes are often extensive, and it is important for all stakeholders to use the same form so that information is consistent. As such, WCB may announce that it will not accept older versions of an updated form after a certain date. The table below has the most recent version of each form, and where older versions are no longer accepted, includes the notation "Only current version accepted."
Original Signature Requirement
Popular Forms
- VF-1 Notice to Political Subdivision of Volunteer Firefighter's Injury or Death
- VF-3 Volunteer Firefighter's Claim for Benefits
- VAW-3 Volunteer Ambulance Worker's Claim for Benefits
| Form Number / Version Date |
Form Title | Who Files | Where to File | When to File |
|---|---|---|---|---|
|
C-2F (9/23) Paper Version
[C-2F Instructions] |
Employer's Report of Work-Related Injury/Illness | Employer (contact your insurer who can provide advice for the best method to report the information.) | Workers' Compensation Board, copy to insurer. | Within 10 days after occurrence of Injury/Illness. |
| Language Access Comment Form | Form is for both internal and external use. | Workers' Compensation Board | New York State’s policy is to provide language access to public services and programs. If you feel that we have not provided you with adequate interpretation services or have denied you an available translated document, please ask for our complaint form to give us your feedback. | |
| VAW-1 (8/97) | Notice to Liable Political Subdivision of Volunteer Ambulance Worker's Injury or Death | Volunteer Ambulance Worker | Send to political subdivision liable for benefits. [This is not a claim for benefits. See VAW-3] | Within 90 days after date of injury or death (unless claim form VAW-3 or VAW-62 is filed within that period). |
| VAW-3 (6/22) | Volunteer Ambulance Worker's Claim for Benefits | Volunteer Ambulance Worker | Workers' Compensation Board, and political subdivision liable for benefits. [If filed within 90 days of injury, it is not necessary to file VAW-1.] | Within 2 years after injury is incurred. |
| VAW-62 (1/11) | Claim for Volunteer Ambulance Workers' Benefits in a Death Case | Claimant | Workers' Compensation Board and designated officer (see detailed instructions on form) | Within two years after death (but see also Form VAW-1) |
| VAW-105 (9/16) | Notice of Compliance - Volunteer Ambulance Workers' Law | Political Subdivision or Unaffiliated Volunteer Ambulance Service insured for Volunteer Ambulance Workers' Benefits through an insurance carrier or Board-approved self-insurance. | This form is not filed. It must be completed by the insurance carrier or self-insured political subdivision or unaffiliated ambulance service with identifying insurance information and then displayed in the ambulance company headquarters. | Upon securing of volunteer ambulance workers' insurance or self-insurance. Political subdivisions or unaffiliated ambulance services must obtain this form from their insurance carrier or group self-insurance administrator. |
| VF-1 (8/97) | Notice to Political Subdivision of Volunteer Firefighter's Injury or Death | Volunteer Firefighter | Send to political subdivision liable for benefits. [This is not a claim for benefits. See VF-3] | Within 90 days after date of injury or death (unless claim form VF-3 or VF-62 is filed within that period) |
| VF-3 (6/22) | Volunteer Firefighter's Claim for Benefits | Volunteer Firefighter | Workers' Compensation Board, and political subdivision liable for benefits. [If filed within 90 days of injury, it is not necessary to file VF-1.] | Within 2 years after injury is incurred. |
| VF-62 (1/11) | Claim for Volunteer Firefighter Benefits in a Death Case | Claimant | Workers' Compensation Board and designated officer (see detailed instructions on form) | Within two years after death (but see also Form VF-1) |
| VF-105 (9/16) | Notice of Compliance - Volunteer Firefighters Benefit Law | Political Subdivision insured for Volunteer Firefighters' Benefits through an insurance carrier or Board-approved self-insurance. | This form is not filed. It must be completed by the insurance carrier or self-insured political subdivision with identifying insurance information and then displayed in the firehouse and fire company headquarters. | Upon securing of volunteer firefighters' insurance or self-insurance. Political subdivisions must obtain this form from their insurance carrier or group self-insurance administrator. |
| VF/VAW-10 (12/21) | Insurer's Request for Benefit Increase Reimbursement Under Sec. 51 VFBL/VAWBL | Insurance Carrier/Self-Insurer | Send your request along with any required documentation to: SpecialFunds@wcb.ny.gov | Claims for reimbursement should be submitted for 52 week periods, beginning one year from the date of the first payment, and annually thereafter while payments continue. |
| VF/VAW-11C (6/22) | Volunteer's Notification of Executive Officer of Fire/Ambulance Company of Significant Risk of Transmission of HIV Per VFBL/VAWBL Section 11-c(1) | Volunteer Firefighter or Volunteer Ambulance Worker | Executive Officer of Fire Company or Ambulance Company, copy to the Workers' Compensation Board | Following significant risk of transmission of HIV incurred in the line of duty as a volunteer firefighter or ambulance worker. Executive Officer must authorize appropriate medical examination within 8 hours of receipt of Form VF/VAW-11C. Contact the nearest office of the Workers' Compensation Board if authorization is not granted within that time. THIS FORM IS NOT A NOTICE OF INJURY/OCCUPATIONAL DISEASE OR A CLAIM FOR BENEFITS UNDER THE VFBL OR VAWBL. (See Forms VF-1, VAW-1, VF-3 and VAW-3) |
| WTC-12 (1/24) | Registration of Participation in World Trade Center Rescue, Recovery and/or Cleanup Operations: Sworn Statement Pursuant to WCL §162 | Employees or volunteers who participated in World Trade Center rescue, recovery and clean-up operations between 9-11-01 and 9-12-02. | Workers' Compensation Board | Not later than September 11, 2026 |
| WTC-16 (7/07) | Cover Sheet: List of Itemized Medical Bills for Temporary Payment by the World Trade Center Volunteer Fund in Controverted World Trade Center Case | Insurance Carrier or Board-approved Self-Insurer | Workers' Compensation Board | Initially within 15 days and monthly thereafter |
| WTC-HIPAA (4/17) | World Trade Center Volunteer Health Insurance Portability and Accountability Act Authorization | Volunteer worker who suffered injury/illness at or near the World Trade Center (Ground Zero) or the Fresh Kills Landfill on or after 9-11-01. | Workers' Compensation Board | File with Form WTCVol-3. See form for complete instructions. |
| WTC-VCF-AUTH (12/21) | World Trade Center September 11th Victim Compensation Fund (VCF) Authorization | Volunteer worker who suffered injury/illness at or near the World Trade Center (Ground Zero) or the Fresh Kills Landfill on or after 9-11-01. | Workers' Compensation Board | File with Form WTCVol-3. See form for complete instructions. |
| WTCVol-3 (6/22) | World Trade Center Volunteer's Claim for Compensation | Volunteer worker who suffered injury/illness at or near the World Trade Center (Ground Zero) or the Fresh Kills Landfill on or after 9-11-01. | Workers' Compensation Board, PO Box 5205, Binghamton, NY 13902-5205 | After filing a timely WTC-12, file a claim. See form for complete instructions. |
If the form you are looking for is not listed above, or in the list of Common Board Forms, please email the Board.