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Form A-9H 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 (Haitian Creole)
This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York.
The document is provided in Haitian Creole. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form A-9H?
A: Form A-9H is a notice regarding potential responsibility for medical costs.
Q: What does Form A-9H inform about?
A: Form A-9H informs the recipient that they may be responsible for medical costs in certain situations.
Q: When are you considered responsible for medical costs according to Form A-9H?
A: You may be responsible for medical costs if you fail to prosecute, if your compensation claim is disallowed, or if an agreement pursuant to Wcl 32 is approved.
Q: Which state is Form A-9H applicable to?
A: Form A-9H is applicable in the state of New York.
Q: Is Form A-9H available in Haitian Creole?
A: Yes, Form A-9H is available in Haitian Creole in addition to English.
Form Details:
- Released on November 1, 2021;
- 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;
Download a fillable version of Form A-9H by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.
