Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Tables Of Statutory Employee Contributions Disability Benefits Law Form. This is a New York form and can be use in Workers Compensation.
Loading PDF...
Tags: Tables Of Statutory Employee Contributions Disability Benefits Law, DB-791, New York Workers Compensation,
DB-791 (2-00)
TABLES OF STATUTORY EMPLOYEE CONTRIBUTIONS
DISABILITY BENEFITS LAW
Amount of Statutory Contributions of Employees to the Cost
of Providing Disability Benefits
Effective July 1, 1983 - Section 209, subdivision 3
Table I - for employees paid weekly
Table II - for employees paid daily
Table III - for employees paid bi-weekly
Table IV - for employees paid semi-monthly
Table V - for employees paid monthly
TABLE I
(for employees paid weekly)
WAGES
EMPLOYEE CONTRIBUTION
$0.00 - 0.99
None
1.00 - 2.99
.01
3.00 - 4.99
.02
5.00 - 6.99
.03
7.00 - 8.99
.04
9.00 - 10.99
.05
11.00 - 12.99
.06
13.00 - 14.99
.07
15.00 - 16.99
.08
17.00 - 18.99
.09
19.00 - 20.99
.10
21.00 - 22.99
.11
23.00 - 24.99
.12
25.00 - 26.99
.13
27.00 - 28.99
.14
29.00 - 30.99
.15
31.00 - 32.99
.16
33.00 - 34.99
.17
2001 © American LegalNet, Inc.
35.00 - 36.99
.18
37.00 - 38.99
.19
39.00 - 40.99
.20
41.00 - 42.99
.21
43.00 - 44.99
.22
45.00 - 46.99
.23
47.00 - 48.99
.24
49.00 - 50.99
.25
51.00 - 52.99
.26
53.00 - 54.99
.27
55.00 - 56.99
.28
57.00 - 58.99
.29
59.00 - 60.99
.30
61.00 - 62.99
.31
63.00 - 64.99
.32
65.00 - 66.99
.33
67.00 - 68.99
.34
69.00 - 70.99
.35
71.00 - 72.99
.36
73.00 - 74.99
.37
75.00 - 76.99
.38
77.00 - 78.99
.39
79.00 - 80.99
.40
81.00 - 82.99
.41
83.00 - 84.99
.42
85.00 - 86.99
.43
87.00 - 88.99
.44
89.00 - 90.99
.45
91.00 - 92.99
.46
93.00 - 94.99
.47
95.00 - 96.99
.48
97.00 - 98.99
.49
99.00 - 100.99
.50
2001 © American LegalNet, Inc.
101.00 - 102.99
.51
103.00 - 104.99
.52
105.00 - 106.99
.53
107.00 - 108.99
.54
109.00 - 110.99
.55
111.00 - 112.99
.56
113.00 - 114.99
.57
115.00 - 116.99
.58
117.00 - 118.99
.59
119.00 and over
.60
(Do not deduct more than $.60 per pay period for employees paid weekly.)
TABLE II
(for employees paid daily)
WAGES
EMPLOYEE CONTRIBUTION
$ 0.00 - 0.99
None
1.00 - 2.99
.01
3.00 - 4.99
.02
5.00 - 6.99
.03
7.00 - 8.99
.04
9.00 - 10.99
.05
11.00 - 12.99
.06
13.00 - 14.99
.07
15.00 - 16.99
.08
17.00 - 18.99
.09
19.00 - 20.99
.10
21.00 - 22.99
.11
23.00 - 24.99
.12
25.00 - 26.99
.13
27.00 and over
.14
(Do not deduct more than $.14 per day for employees paid daily.)
2001 © American LegalNet, Inc.
TABLE III
(for employees paid bi-weekly)
WAGES
EMPLOYEE CONTRIBUTION
$0.00 - $118.99
Use Table I
119.00 - 120.99
.60
121.00 - 122.99
.61
123.00 - 124.99
.62
125.00 - 126.99
.63
127.00 - 128.99
.64
129.00 - 130.99
.65
131.00 - 132.99
.66
133.00 - 134.99
.67
135.00 - 136.99
.68
137.00 - 138.99
.69
139.00 - 140.99
.70
141.00 - 142.99
.71
143.00 - 144.99
.72
145.00 - 146.99
.73
147.00 - 148.99
.74
149.00 - 150.99
.75
151.00 - 152.99
.76
153.00 - 154.99
.77
155.00 - 156.99
.78
157.00 - 158.99
.79
159.00 - 160.99
.80
161.00 - 162.99
.81
163.00 - 164.99
.82
165.00 - 166.99
.83
167.00 - 168.99
.84
169.00 - 170.99
.85
171.00 - 172.99
.86
173.00 - 174.99
.87
2001 © American LegalNet, Inc.
175.00 - 176.99
.88
177.00 - 178.99
.89
179.00 - 180.99
.90
181.00 - 182.99
.91
183.00 - 184.99
.92
185.00 - 186.99
.93
187.00 - 188.99
.94
189.00 - 190.99
.95
191.00 - 192.99
.96
193.00 - 194.99
.97
195.00 - 196.99
.98
197.00 - 198.99
.99
199.00 - 200.99
1.00
201.00 - 202.99
1.01
203.00 - 204.99
1.02
205.00 - 206.99
1.03
207.00 - 208.99
1.04
209.00 - 210.99
1.05
211.00 - 212.99
1.06
213.00 - 214.99
1.07
215.00 - 216.99
1.08
217.00 - 218.99
1.09
219.00 - 220.99
1.10
221.00 - 222.99
1.11
223.00 - 224.99
1.12
225.00 - 226.99
1.13
227.00 - 228.99
1.14
229.00 - 230.99
1.15
231.00 - 232.99
1.16
233.00 - 234.99
1.17
235.00 - 236.99
1.18
237.00 - 238.99
1.19
239.00 - 240.99
1.20
(Do not deduct more than $1.20 per pay period for employees paid bi-weekly.)
2001 © American LegalNet, Inc.
TABLE IV
(for employees paid semi-monthly)
WAGES
0.00 - 238.99
EMPLOYEE CONTRIBUTION
Use Table III
239.00 - 240.99
1.20
241.00 - 242.99
1.21
243.00 - 244.99
1.22
245.00 - 246.99
1.23
247.00 - 248.99
1.24
249.00 - 250.99
1.25
251.00 - 252.99
1.26
253.00 - 254.99
1.27
255.00 - 256.99
1.28
257.00 - 258.99
1.29
259.00 - and over
1.30
(Do not deduct more than $1.30 per pay period for employees paid
semi-monthly.)
TABLE V
(for employees paid monthly)
WAGES
EMPLOYEE CONTRIBUTION
$0.00 - $258.99
Use Table IV
259.00 - 260.99
1.30
261.00 - 262.99
1.31
263.00 - 264.99
1.32
265.00 - 266.99
1.33
267.00 - 268.99
1.34
269.00 - 270.99
1.35
271.00 - 272.99
1.36
273.00 - 274.99
1.37
275.00 - 276.99
1.38
277.00 - 278.99
1.39
279.00 - 280.99
1.40
2001 © American LegalNet, Inc.
281.00 - 282.99
1.41
283.00 - 284.99
1.42
285.00 - 286.99
1.43
287.00 - 288.99
1.44
289.00 - 290.99
1.45
291.00 - 292.99
1.46
293.00 - 294.99
1.47
295.00 - 296.99
1.48
297.00 - 298.99
1.49
299.00 - 300.99
1.50
301.00 - 302.99
1.51
303.00 - 304.99
1.52
305.00 - 306.99
1.53
307.00 - 308.99
1.54
309.00 - 310.99
1.55
311.00 - 312.99
1.56
313.00 - 314.99
1.57
315.00 - 316.99
1.58
317.00 - 318.99
1.59
319.00 - 320.99
1.60
321.00 - 322.99
1.61
323.00 - 324.99
1.62
325.00 - 326.99
1.63
327.00 - 328.99
1.64
329.00 - 330.99
1.65
331.00 - 332.99
1.66
333.00 - 334.99
1.67
335.00 - 336.99
1.68
337.00 - 338.99
1.69
339.00 - 340.99
1.70
341.00 - 342.99
1.71
343.00 - 344.99
1.72
345.00 - 346.99
1.73
347.00 - 348.99
1.74
2001 © American LegalNet, Inc.
349.00 - 350.99
1.75
351.00 - 352.99
1.76
353.00. - 354.99
1.77
355.00 - 356.99
1.78
357.00 - 358.99
1.79
359.00 - 360.99
1.80
361.00 - 362.99
1.81
363.00 - 364.99
1.82
365.00 - 366.99
1.83
367.00 - 368.99
1.84
369.00 - 370.99
1.85
371.00 - 372.99
1.86
373.00 - 374.99
1.87
375.00 - 376.99
1.88
377.00 - 378.99
1.89
379.00 - 380.99
1.90
381.00 - 382.99
1.91
383.00 - 384.99
1.92
385.00 - 386.99
1.93
387.00 - 388.99
1.94
389.00 - 390.99
1.95
391.00 - 392.99
1.96
393.00 - 394.99
1.97
395.00 - 396.99
1.98
397.00 - 398.99
1.99
399.00 - 400.99
2.00
401.00 - 402.99
2.01
403.00 - 404.99
2.02
405.00 - 406.99
2.03
407.00 - 408.99
2.04
409.00 - 410.99
2.05
411.00 - 412.99
2.06
413.00 - 414.99
2.07
415.00 - 416.99
2.08
2001 © American LegalNet, Inc.
417.00 - 418.99
2.09
419.00 - 420.99
2.10
421.00 - 422.99
2.11
423.00 - 424.99
2.12
425.00 - 426.99
2.13
427.00 - 428.99
2.14
429.00 - 430.99
2.15
431.00 - 432.99
2.16
433.00 - 434.99
2.17
435.00 - 436.99
2.18
437.00 - 438.99
2.19
439.00 - 440.99
2.20
441.00 - 442.99
2.21
443.00 - 444.99
2.22
445.00 - 446.99
2.23
447.00 - 448.99
2.24
449.00 - 450.99
2.25
451.00 - 452.99
2.26
453.00 - 454.99
2.27
455.00 - 456.99
2.28
457.00 - 458.99
2.29
459.00 - 460.99
2.30
461.00 - 462.99
2.31
463.00 - 464.99
2.32
465.00 - 466.99
2.33
467.00 - 468.99
2.34
469.00 - 470.99
2.35
471.00 - 472.99
2.36
473.00 - 474.99
2.37
475.00 - 476.99
2.38
477.00 - 478.99
2.39
479.00 - 480.99
2.40
481.00 - 482.99
2.41
483.00 - 484.99
2.42
2001 © American LegalNet, Inc.
485.00 - 486.99
2.43
487.00 - 488.99
2.44
489.00 - 490.99
2.45
491.00 - 492.99
2.46
493.00 - 494.99
2.47
495.00 - 496.99
2.48
497.00 - 498.99
2.49
499.00 - 500.99
2.50
501.00 - 502.99
2.51
503.00 - 504.99
2.52
505.00 - 506.99
2.53
507.00 - 508.99
2.54
509.00 - 510.99
2.55
511.00 - 512.99
2.56
513.00 - 514.99
2.57
515.00 - 516.99
2.58
517.00 - 518.99
2.59
519.00 and over
2.60
(Do not deduct more than $2.60 per pay period for employees paid monthly.)
2001 © American LegalNet, Inc.
