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NYS Workers ' Compensation Board, Centralized Mailing, PO Box 5205, Binghamton, NY 13902-5205 Customer Service Toll-Free Line: 877-632-4996 THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES.

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How to fill out the Oc 400 1 online

This guide provides clear and comprehensive instructions for filling out the Oc 400 1 form online. Designed for users with varying levels of experience, it will walk you through each section to ensure a smooth and efficient submission process.

Follow the steps to successfully complete your Oc 400 1 form online.

  1. Click ‘Get Form’ button to access the form and open it in the online editor.
  2. Enter your WCB Case Number in the designated field at the top of the form.
  3. Provide the claimant's name clearly as it appears in the records.
  4. If applicable, include the representative's identification number in the specified section.
  5. Input the claimant's Social Security Number accurately in the appropriate field.
  6. Fill in the date you retained the attorney or representative in the 'Date Retained' section.
  7. List the total amount of fees previously received, if any, where indicated.
  8. In the services rendered section, detail each service provided to the claimant, including the date, a description, and the time spent on each service. Also, include any disbursements incurred.
  9. For substitution of attorney, indicate if the claimant had any previous attorney and whether notice of substitution was served.
  10. Complete the fee request details, stating the specific amount requested for the services rendered.
  11. Sign and date the application at the bottom of the form.
  12. Review all information for accuracy, then save changes, download, print, or share the completed form as needed.

Start filling out your Oc 400 1 form online today to ensure timely processing of your fee request.

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Oc 400 1
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