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Get and Sign DB 136 Employer's Application for Voluntary Coverage for Class of Employees for Whom Disability and Paid Family Leave Benefits a 2019-2022 Form

Get and Sign DB 136 Employer's Application for Voluntary Coverage for Class of Employees for Whom Disability and Paid Family Leave Benefits a 2019-2022 Form

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Number): Total Number of Employees: Number of employees in class or classes for whom disability and paid family leave benefits are not required by law: A. The EMPLOYER represents that he/she is is not a covered employer within the definition thereof in Section 202 of the New York State Disability and Paid Family Leave Benefits Law. B. The EMPLOYER hereby gives notice of his/her election, under Section 212 of the Law, to provide disability and paid family leave benefits to the extent and in...
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