Oc 110a form fillable 2007-2025

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The document is a form from the New York State Workers' Compensation Board that allows claimants to authorize the disclosure of their workers' compensation records. It outlines the necessary information required for authorization, restrictions on releasing information to prospective employers, and legal implications for unauthorized disclosure. The form must be submitted to the Board, and claimants can revoke their authorization at any time.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (81 Votes)
2007	4.4 Satisfied (92 Votes)

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