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 Russian. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form A-9?
A: Form A-9 is a notice in New York related to potential responsibility for medical costs.
Q: What does Form A-9 inform about?
A: Form A-9 informs individuals about their potential responsibility for medical costs.
Q: When does Form A-9 apply?
A: Form A-9 applies in cases of failure to prosecute or if a compensation claim is disallowed, or if an agreement pursuant to WCL 32 is approved.
Q: What is WCL 32?
A: WCL 32 refers to a specific section of the New York Workers' Compensation Law.
Q: Who receives Form A-9?
A: Form A-9 may be received by individuals involved in workers' compensation cases in New York.
Q: Why might someone receive Form A-9?
A: Someone may receive Form A-9 if their compensation claim is disallowed or if they fail to prosecute their case.
Q: What is the purpose of Form A-9?
A: The purpose of Form A-9 is to notify individuals of their potential responsibility for medical costs in specific circumstances.
Q: Is Form A-9 specific to the Russian language?
A: No, Form A-9 exists in different languages, including Russian.
Form Details:
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.