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. Please contact the Licensing Office at 1-800-664-2379 for information as to when the next written exam will be held, along with the registration deadline date.
|Form Number / Version Date||Form Title||Who Files||When to File|
& Study Guide
|Initial Application to Take License Representative Exam||This form is to be completed by individual taking exam.||Must be postmarked no later than three weeks prior to examination.|