Renewal Application For License To Appear On Behalf Of Claimant {OC-401.1R}

OC-401.1R - RENEWAL APPLICATION FOR LICENSE TO APPEAR ON BEHALF OF CLAIMANT. This form is used under Section 24-a of the Workers' Compensation Law & Rules with respect to granting licenses to representatives of claimants. It is for individuals seeking a license to represent claimants in workers' compensation matters. The form includes personal information about the applicant, details about their education and professional background, questions about any other licenses or authorizations, and inquiries about past legal or disciplinary actions. Additionally, it requires the applicant to provide information on their business activities, arrangements with health care providers or labor organizations, and details on income and expenses related to workers' compensation representation. The form concludes with the applicant's affirmation, acknowledging the penalties of perjury for providing false information. www.FormsWorkflow.com