New York Temporary Disability Benefits Law Statement of Rights (DB-271S)
Entity Mandating Notice: New York State Workers' Compensation Board.
Applicability: Employers covered by the New York temporary disability benefits law.
Distribution Specifications: A covered employer must provide a notice of rights to employees who are absent for more than seven consecutive days due to a nonwork-related illness or injury or a pregnancy-related disability. The notice must be provided within five business days after the employee's seventh consecutive day of absence or after the employer learns the absence is due to disability, whichever is later.
Obtaining This Notice: An employer may download this form directly from the Workers' Compensation Board website.