Forms & Applications

If you were exposed at the World Trade Center Disaster, you MUST complete the following two forms before their respective deadlines.

Workers Compensation Notice of Participation

The WTC 12 Form  ** Deadline September 11, 2010

NYCERS Notice of Participation

NYCERS Form #622 ** September 11, 2010

NYS Crime Victims Board

Click To Apply For Financial Benefits

When you get to this site, click FORMS to download an application for funding. 

Workers Compensation

If you have a Workers' Compensation case for your 9/11 injury/illness, you should be putting all your care through the City Law Dept. Even if you are getting treatment at a WTC monitoring & Treatment Center, ask the Center for a C4 with medical back up and submit that to the Law Dept if you are opening or have an open case. 

All prescriptions should be going there too.  If you have been using your union card, please stop!  Call the Injured Workers Pharmacy at 1-888-321-7945.  They will bill the city and mail you your medications within a few days at NO COST TO YOU!  They assign you a personal rep to assist you, send you mailers to send in prescriptions or you can have your doctor call them into their center.  Save time and money, and your union welfare fund.

 

 

What is a Notice of Participation?

A notice of participation is not an application, but a notarized document that states I am eligible to file file for benefits, was a responder at the WTC and reserve my right to file a claim later should I need to.