Get Ny C-251.2 2014-2025

Filling out the NY C-251.2 form is an essential step for carriers seeking reimbursement for compensation payments under section 14-6 for concurrent employment. This guide provides clear, detailed instructions to help you successfully complete the form online.

Follow the steps to complete the NY C-251.2 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the WCB case number and the Carrier case number at the top of the form to identify your claim accurately.
3. Provide the Carrier's name and Carrier ID number where indicated. This information is critical for processing your request.
4. Enter the Social Security number of the person related to the application. Ensure this information is accurate as it will be used for verification.
5. Complete the Carrier's address section. It should be the official address where the carrier conducts business.
6. Fill out the Claimant's name. This should be the name of the individual who is the subject of the reimbursement request.
7. In section A, detail the weeks for which reimbursement is requested. Specify the range of dates, the weekly compensation amount, and the total amount for each entry.
8. For section B, indicate any lump sum payments being requested. Specify the duration in weeks and the corresponding payment amount.
9. If applicable, complete section C by specifying any additional information or requests for reimbursement that are not captured in sections A or B.
10. Calculate the total claim for reimbursement and enter this amount in the designated field.
11. Respond to the question regarding whether this claim represents an initial request for reimbursement. Attach the required Notice of Decision if necessary.
12. Attach copies of all claimant status checks as required by the instructions.
13. Ensure you include Form SROI-SA in your submission. This is a mandatory requirement for your request.
14. Sign and date the statement at the bottom of the form. Include your title and telephone number for any follow-up.
15. Once completed, save your changes, download the form, and print it as necessary for your records. Share it as needed with the relevant offices.

Complete your NY C-251.2 form online to streamline your reimbursement process.