AVI KI FÈ KONNEN OU KAPAB GEN RESPONSABILITE POU W PEYE FRÈ MEDIKAL YO NAN KA KOTE PA TA GEN PWOSEDI JIDISYÈ KI FÈT, OSWA SI DEMANN REPARASYON AN PA OTORIZE, OSWA SI YO APWOUVE AKÒ AN NAN KONFÒMITE AK WCL §32.

Workers Compensation Board

This government document is issued by Workers Compensation Board for use in New York

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File Details: PDF (471 KB)
Source
https://www.wcb.ny.gov/content/main/forms/A9_HC.pdf

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