Get Ei 4410 Waiver Application - August 2014.qxp - Op Nysed

Filling out the EI 4410 Waiver Application is a crucial step for entities seeking to obtain a waiver of corporate practice prohibitions under New York State law. This guide provides a detailed, step-by-step approach to completing the application online, ensuring that you have all the necessary information and support throughout the process.

Follow the steps to successfully complete your waiver application.

1. To begin, use the ‘Get Form’ button to obtain the EI 4410 Waiver Application and open it in the online editor.
2. Enter the legal name of the entity seeking the waiver in the designated field.
3. Provide the primary address of the entity, including street number, city, state, zip code, and contact details such as telephone, fax, email, and website.
4. Indicate the federal and state employer identification numbers (EIN) for the entity.
5. Select whether you are submitting an initial application for waiver or a revised/updated application.
6. Designate a contact person for clarifying information related to the application, including their name, contact number, and email.
7. Check the applicable boxes to indicate if you are applying for a waiver for a Special Education School or an Early Intervention Agency Provider, and ensure to attach the necessary authorization letters.
8. Confirm whether the entity is filed with the NYS Department of State and provide the name on file if applicable.
9. Provide details on the type of ownership for the entity and the assumed name if any.
10. List the professional services to be offered by the entity and indicate whether it will contract with professional services corporations or licensed professionals.
11. Respond to questions regarding any past issues with contracts or licenses, attaching explanations and documents where required.
12. List all directors, officers, trustees, shareholders, or members of the corporate entity, ensuring to include contact information for each, and remember to attach a Moral Character Attestation (Form SE-1) for each individual.
13. Affirm the accuracy of the information provided by signing the attestation section at the bottom of the application.
14. Compile your application with a check for $345 and required documents before mailing it to the specified address.
15. Finally, after submitting, keep track of your application status and be prepared to provide any additional information requested by the Office of the Professions.

Begin your EI 4410 Waiver Application online today to navigate the process smoothly and efficiently.