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1199SEIU Benefit and Pension Funds fax number

(646) 473-6768

Disability Benefits Department

Used for: NYS Notice and Proof of Claim for Disability Benefits

Fax destination details

Department
Disability Benefits Department
Purpose
NYS Notice and Proof of Claim for Disability Benefits
Form
DB-450 — NYS Notice and Proof of Claim for Disability Benefits
Address
498 Seventh Avenue, New York, NY 10018-0009
Voice phone
(646) 473-6710

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Complete Parts A and B; Part C to be completed by the employer; attach any required medical documentation and submit according to the form instructions.

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