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Workers' Compensation Board

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New York State
Workers' Compensation Board
OFFICE OF THE CHAIRMAN
328 State Street  Schenectady, New York 12305
Subject No. 046-103

Please do not send requests for forms to William Bryant. As of July 2007 all requests should be sent to the attention of the "Reproduction Unit".

To:  Insurance Carriers and Self-Insurers Providing Benefits Under the Workers' Compensation Law, Volunteer Firefighters' Law and Volunteer Ambulance Workers' Law

Revised Carrier Reporting Forms: C-251, C-251.1 and C-251.2

Date:  November 1, 2001

Attached are copies of the following prescribed Board forms:

Please note the following changes:

C-251 -- New item 3 regarding third party actions; additional space for carrier address; revised filing instructions. This form should no longer be filed with the Board's Finance Office.

C-251.1 -- Additional space for carrier address; revised filing instructions. This form should no longer be filed with the Board's Finance Office.

C-251.2 -- Additional space for carrier address.

Please note that, unlike most other Board forms, these reports must continue to be filed on colored paper, as follows: C-251 Yellow, C-251.1 Pink, C-251.2 Blue.

Attached Board Forms C-251, C-251.1 and C-251.2 are effective immediately. Carriers and self-insurers are authorized to reproduce them according to their needs. Additional master copies may be obtained from the Board's website at www.wcb.ny.gov, or by writing or faxing the Board at:

New York State Workers' Compensation Board
Attn.: Mr. William Bryant
100 Broadway-Menands
Albany, NY 11241
Fax: (518) 486-7051

 

Robert R. Snashall
Chairman