C 64 Form

What is the C 64 Form

The C 64 form, commonly referred to as the New York C 64, is a crucial document used in the context of workers' compensation claims in New York State. This form is specifically designed for reporting a worker's death due to a work-related injury or illness. It serves as an official notification to the Workers' Compensation Board, enabling the initiation of benefits for the deceased worker's dependents. Understanding the purpose and significance of the C 64 form is essential for employers and family members navigating the complexities of workers' compensation law.

How to use the C 64 Form

Using the C 64 form involves several key steps to ensure that it is completed accurately and submitted correctly. First, gather all necessary information, including the deceased worker's personal details, the circumstances surrounding their death, and any relevant medical documentation. Next, fill out the form carefully, ensuring that all sections are completed to avoid delays in processing. Once the form is filled out, it must be submitted to the New York Workers' Compensation Board, either online or via mail, depending on your preference. Utilizing a reliable eSignature solution can streamline this process, making it easier to sign and submit the form electronically.

Steps to complete the C 64 Form

Completing the C 64 form requires attention to detail and adherence to specific guidelines. Follow these steps for successful completion:

• Begin by entering the deceased worker's name, address, and Social Security number.
• Provide details about the employer, including the business name and address.
• Describe the circumstances of the worker's death, including the date and nature of the work-related incident.
• Attach any supporting documents, such as medical records or death certificates, to substantiate the claim.
• Review the form for accuracy before signing it electronically or by hand.
• Submit the completed form to the appropriate Workers' Compensation Board office.

Legal use of the C 64 Form

The legal use of the C 64 form is governed by New York State workers' compensation laws. To ensure its validity, the form must be completed accurately and submitted within the designated time frames. Electronic submissions are recognized as legally binding, provided they comply with the Electronic Signatures in Global and National Commerce (ESIGN) Act and other relevant regulations. Utilizing a secure eSignature platform can enhance the legal standing of the submitted form, ensuring that it meets all necessary compliance requirements.

Key elements of the C 64 Form

Understanding the key elements of the C 64 form is essential for accurate completion. The form typically includes the following sections:

• Identification details of the deceased worker.
• Employer information, including contact details.
• Details of the incident leading to death, including the date and description.
• Information regarding beneficiaries or dependents entitled to benefits.
• Signature of the individual completing the form, affirming the accuracy of the information provided.

Form Submission Methods (Online / Mail / In-Person)

The C 64 form can be submitted through various methods to accommodate different preferences and situations. Options include:

• Online: Utilize the New York Workers' Compensation Board's online portal for electronic submission, which allows for faster processing.
• Mail: Send the completed form via postal service to the designated Workers' Compensation Board office.
• In-Person: Deliver the form directly to a local Workers' Compensation Board office for immediate processing.