STATE OF NEW YORK - DEPARTMENT OF LABOR
Form # Form Title DB 120.1 Certificate of Disability Benefit Insurance DB 155 Certificate of Disability Benefit Self-Insurance CE 200 Certificate of Attestation of Exemption – (no employees) For forms or general questions, contact the Disability Benefits Bureau at (518) 486-6307. We do not accept ACORD Forms as proof of insurance coverage. ................
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