Site Navigation

WCB Home Page
Change Font Size
Glossary of WCB Terms

Application Form and Instructions on How to Become a Licensed Representative


The Licensed Representative Examination Process

The Workers Compensation Board (WCB) has scheduled the Licensed Representative Exam for Thursday, June 12, 2014 at 9:30 AM [arrival required by 8:30 AM] at the WCB office located at 328 State Street, Schenectady, New York. Depending upon the number of applicants, it may also be held at a second WCB office located at 100 Broadway, Menands, New York. Please see the Licensed Representative Examination Guide for further details.

Please keep checking this site for any further details or updates (including any updates related to date/time/location).

Applicants seeking a license to represent claimants pursuant to Section 24-a of the Workers' Compensation Law, or to become a third-party administrator (TPA) to represent self-insured employers and/or insurance carriers should complete Form OC-409 and submit it to the Licensing Office at 328 State Street, Schenectady, NY 12305-2318, along with a $100 check or money order payable to the "Chair, Workers' Compensation Board", with each application. Complete applications accompanied by the required fee are due by close of business Wednesday, April 30, 2014.

Licensed Representatives Regulations

Application Form and Examination Guide for Licensing Representative Exam
Form Number / Version Date Form Title Who Files When to File
OC-409 (05/99) adobe pdf
Exam Guideadobe pdf
Initial Application to Take License Representative Exam This form is to be completed by individual taking exam. Complete applications accompanied by the required fee are due by close of business Wednesday, April 30, 2014.