DB-300 Claim Form

DB-300: Notice and proof of Claim for Disability Benefits by Unemployed Claimant

Use the DB-300 form to apply for New York State disability benefits if you became disabled or sick after more than four weeks of unemployment. To apply for these benefits, you and your healthcare provider must complete a DB-300 form, which is also known as a Notice and Proof of Claim for Disability Benefits Form by Unemployed Claimant. Print this form and apply for disability benefits now.

We urge that you not submit this form until it has been reviewed by an attorney who is aware of all the facts and circumstances of your matter. Need help? Contact a car accident injury attorney today!

Download the DB-300 form.