Get Ny Wtc-12 2009
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How to fill out the NY WTC-12 online
This guide provides step-by-step instructions for completing the NY WTC-12 form, designed for participants in World Trade Center rescue, recovery, and cleanup operations. By following these instructions, users can effectively navigate the form and ensure their submissions are accurate and complete.
Follow the steps to successfully complete the NY WTC-12 form
- Press the ‘Get Form’ button to obtain the NY WTC-12 form and open it in your online editor.
- Provide your current residential address, including apartment number (if applicable), street number, street name, city, state, and zip code. If your mailing address differs from your residential address, include that as well. Make sure to also include your telephone number, Social Security number, and date of birth in the required format.
- Confirm that you participated in the World Trade Center operations between September 11, 2001, and September 12, 2002, at the specified locations: the World Trade Center site, Fresh Kills Land Fill, New York City morgue, or on the barges.
- Indicate whether your role was as an employee or a volunteer. Detail any evidence of your activities, such as badges, letters, statements, or photographs.
- In the provided table, fill in the dates and locations of your participation. Describe the work you performed at each location and provide the complete name and address of your employer or rescue agency, as well as the insurance carrier if known.
- State whether you have previously filed a workers' compensation claim with the Board related to your participation. If so, specify the date of the claim and the WCB case number.
- Acknowledge your understanding that registering with the Board does not equate to filing a claim for benefits. Make sure to clarify that you know to submit either Form C-3 or Form WTCVol-3 to file a claim.
- Confirm your awareness of the penalties for submitting false written documents or making false statements. Sign the Sworn Statement in front of a notary public, ensuring that your signature is notarized.
- Once the Sworn Statement is completed and notarized, file the original version with the Board by the deadline.
Complete your NY WTC-12 form online today to ensure your participation is registered.
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Filing a workers' comp claim can be worth it, especially if your injury impacts your ability to work or leads to significant medical expenses. Financial benefits from the claim can help you cover lost wages and medical bills, providing peace of mind during recovery. Evaluating your situation and consulting experts can help you navigate the complexities of the NY WTC-12 effectively.
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