Use this form to show your efforts to attach to the labor market.
Hearing: this form and all documents supporting your job search efforts must be submitted to the Board in advance of your hearing.
Documents: you or your attorney can email or use eCase Document Upload at least three days before your hearing.
Part-time: part-time enrollment does not meet the requirements of the law necessary to show attachment to the labor market.
Benefits: benefits may be suspended if the Board issues a decision finding that your efforts were not sufficient.
Evidence: this document will be considered evidence by the NYS Workers' Compensation Board.
| Question | Answer |
|---|---|
| Form Name | Form C-258 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 36 |
| Avg. time to fill out | 6 min |
| Edition | 5-19 |
| Where to send | If you are not represented by counsel, you can mail to the Board at PO Box 5205, Binghamton, NY 13902-5205 at least six days prior to the date of your hearing |
| Other names | C-258, C258, C 258, Form C258, Claimant's Record of Job Search Efforts/Contacts |
| State | New York |
| Issuing Agency | NY Workers' Compensation Board |
| Purpose | Claimant's Record of Job Search Efforts/Contacts |
| Official source | Form C-258 (Rev 5-19), New York State Workers' Compensation Board |
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