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Form A-9 Notice That You May Be Responsible for Medical Costs in the Event of Failure to Prosecute, or if Compensation Claim Is Disallowed, or if Agreement Pursuant to Wcl 32 Is Approved - New York (English / Spanish)
What Is Form A-9?
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form A-9?
A: Form A-9 is a notice regarding potential responsibility for medical costs.
Q: What does Form A-9 cover?
A: Form A-9 covers situations where there is a failure to prosecute, a disallowed compensation claim, or an approved agreement according to WCL 32.
Q: Is Form A-9 available in English and Spanish?
A: Yes, Form A-9 is available in both English and Spanish.
Form Details:
- Released on January 1, 2007;
- The latest edition provided by the New York State Workers' Compensation Board;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form A-9 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
Download Form A-9 Notice That You May Be Responsible for Medical Costs in the Event of Failure to Prosecute, or if Compensation Claim Is Disallowed, or if Agreement Pursuant to Wcl 32 Is Approved - New York (English / Spanish)
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