Db 136 2003-2025 Form

What is the DB136?

The DB136 form, officially known as the New York State Voluntary Coverage Form, is a document used for applying for voluntary disability insurance coverage in New York. This form is essential for employers seeking to provide additional coverage for their employees beyond the mandatory disability benefits. The DB136 allows businesses to opt into a program that offers enhanced protection for their workforce, ensuring that employees receive adequate financial support in case of a disability.

How to Use the DB136

Utilizing the DB136 involves several straightforward steps. First, employers must fill out the form accurately, providing necessary information about their business and the employees they intend to cover. After completing the form, it should be submitted to the New York State Workers' Compensation Board for approval. The form must be signed by an authorized representative of the business. Once approved, the coverage becomes effective, providing employees with the additional disability benefits they need.

Steps to Complete the DB136

Completing the DB136 requires careful attention to detail. Follow these steps:

• Gather necessary information about your business, including the business name, address, and contact details.
• Provide employee information, including names and social security numbers, for those who will be covered under the voluntary plan.
• Review the coverage options available and select the appropriate plan that meets your business needs.
• Ensure that all sections of the form are filled out completely to avoid delays in processing.
• Sign the form where indicated, confirming that the information provided is accurate.
• Submit the completed form to the New York State Workers' Compensation Board.

Legal Use of the DB136

The DB136 form is legally binding once it has been properly completed and submitted. Compliance with state regulations is crucial, as it ensures that the coverage provided meets the legal standards set forth by New York law. It is important to keep records of the submission and any correspondence with the Workers' Compensation Board to maintain compliance and address any potential disputes regarding coverage.

Key Elements of the DB136

Several key elements must be included in the DB136 form to ensure its validity:

• Business Information: Accurate details about the employer, including the business name and address.
• Employee Information: Names and social security numbers of employees being covered.
• Coverage Options: Clear selection of the type of voluntary coverage being applied for.
• Signature: An authorized representative must sign the form to validate the application.

Form Submission Methods

The DB136 form can be submitted through various methods to accommodate different preferences. Employers can choose to submit the form online via the New York State Workers' Compensation Board's website, or they can opt for traditional methods such as mailing the form or delivering it in person to the appropriate office. Each method has its own processing times, so employers should choose the one that best fits their timeline.