This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form OC-110A?
A: Form OC-110A is the Claimant's Authorization to Disclose Workers' Compensation Records in New York.
Q: What is the purpose of Form OC-110A?
A: The purpose of Form OC-110A is to authorize the release of your workers' compensation records.
Q: When is Form OC-110A used?
A: Form OC-110A is used when you want to allow someone access to your workers' compensation records.
Q: Who can use Form OC-110A?
A: Any claimant in New York who wants to disclose their workers' compensation records can use Form OC-110A.
Q: Is Form OC-110A mandatory?
A: No, Form OC-110A is not mandatory. It is optional, and you can choose to sign and authorize the release of your workers' compensation records.
Q: What information is required on Form OC-110A?
A: On Form OC-110A, you will need to provide your personal information and the specific individuals or organizations you are authorizing to access your workers' compensation records.
Q: How do I submit Form OC-110A?
A: Once you have completed and signed Form OC-110A, you can submit it to the appropriate party, such as your employer, insurance company, or attorney.
Q: Can I revoke the authorization on Form OC-110A?
A: Yes, you can revoke the authorization on Form OC-110A at any time by providing written notice to the party you initially authorized.
Q: Is there a fee for filing Form OC-110A?
A: No, there is no fee for filing Form OC-110A. It is a free form provided by the New York Workers' Compensation Board.
Form Details:
Download a fillable version of Form OC-110A by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.