PDF
Word
Form DB-212.5 Notice of Election to Voluntarily Exclude Spouse From Coverage Pursuant to Section 212, Subdivision 5 of the NYS Disability and Paid Family Leave Benefits Law - New York
What Is Form DB-212.5?
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 DB-212.5?
A: Form DB-212.5 is the Notice of Election to Voluntarily Exclude Spouse From Coverage.
Q: What does Form DB-212.5 allow you to do?
A: Form DB-212.5 allows you to voluntarily exclude your spouse from coverage under the NYS Disability and Paid Family Leave Benefits Law.
Q: What is the purpose of excluding a spouse from coverage?
A: The purpose of excluding a spouse from coverage is to opt out of providing disability and paid family leave benefits for your spouse.
Q: What is Section 212, Subdivision 5 of the NYS Disability and Paid Family Leave Benefits Law?
A: Section 212, Subdivision 5 of the NYS Disability and Paid Family Leave Benefits Law is the specific section that allows for the voluntary exclusion of a spouse from coverage.
Form Details:
- Released on October 1, 2017;
- 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 fillable version of Form DB-212.5 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
Download Form DB-212.5 Notice of Election to Voluntarily Exclude Spouse From Coverage Pursuant to Section 212, Subdivision 5 of the NYS Disability and Paid Family Leave Benefits Law - New York
1
2
