N.Y. Comp. Codes R. & Regs. tit. 9 § 210.4

Current through Register Vol. 46, No. 50, December 11, 2024

Section 210.4 - Documentation

(a) Fire districts, departments and companies shall provide information on the enhanced cancer disability benefit to all its members and make available such information upon request.

(b) Upon request, the fire district, department or company shall provide a claim form and instructions to its member or their beneficiary(ies) detailing how to file a claim for enhanced cancer benefits with the benefits provider.

(c) As part of any claim submitted and filed with the benefit provider, fire districts, departments and companies shall provide a certification of eligibility for enhanced cancer disability benefits using a form prescribed by the office of fire prevention and control. This form must be signed by the head of the department or company, sworn to under penalty of perjury as true, correct and complete, notarized and contain, at a minimum, the following information:

(1) The full legal name of the eligible volunteer firefighter;

(2) The full legal name of the fire district, department or company;

(3) The dates the eligible volunteer firefighter was an active volunteer firefighter of the fire district, department or company;

(4) The number of years of firefighting service as an interior firefighter;

(5) A statement that the eligible volunteer firefighter performed interior structural firefighting duties inside a building; and

(6) A statement that the eligible volunteer firefighter successfully completed a physical examination, prior to the commencement of duties as an interior firefighter, which failed to reveal any evidence of cancer;

N.Y. Comp. Codes R. & Regs. Tit. 9 § 210.4

Adopted New York State Register October 17, 2018/Volume XL, Issue 40, eff. 10/17/2018