Get Ny Oc-400.1 2017-2025

The NY OC-400.1 form is used to request fees by a claimant's attorney or licensed representative in accordance with Board Rule 12 NYCRR 300.17. This guide provides a clear, step-by-step process for completing the form online to ensure that all necessary information is accurately submitted.

Follow the steps to fill out the NY OC-400.1 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the WCB case number(s) in the designated field at the top of the form. This information is essential for linking the fee request to the correct case.
3. Provide the claimant's name in the format of last name, first name, and middle initial. Ensure this is accurate to avoid any issues with processing.
4. Input the representative's identification number, if applicable, and the date retained, formatted as mm/dd/yyyy.
5. In the services rendered section, list the specific services provided to the claimant. Include dates of service and the time spent on each. Be as detailed as possible, and enter the total hours at the end of this section.
6. Document any disbursements related to the services rendered. Note the nature of the disbursement, such as an Independent Medical Examination, along with the associated costs.
7. Complete the certification section by printing the name of the attorney or licensed representative and signing where indicated.
8. Fill out the claimant's section, stating the amount of the fee being requested and whether the claimant objects to this amount. A signature from the claimant is required, or an explanation if it cannot be obtained.
9. Review all provided information for accuracy and completeness to avoid delays in processing.
10. Once completed, save the changes, and choose to download, print, or share the form as needed for submission.

Begin your application process by filling out the NY OC-400.1 form online today.