Form A-9I 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 / Italian)

What Is Form A-9I?

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.

Form Details:

• Released on October 1, 2012;
• The latest edition provided by the New York State Workers' Compensation Board;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a printable version of Form A-9I by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.