Form DPM-1 at a glance
What it is: Form DPM-1 is the application for the New York State Governor's Program to Hire Persons with Disabilities under Sections 55-b and 55-c of the Civil Service Law.
Where and when to file: Send the completed application to the New York State Department of Civil Service 55b/c Program, Albany, NY 12239.
You must be legally eligible to work in the United States at time of appointment and throughout your employment with New York State.
What to bring and attach to Form DPM-1
Your completed application should include Application Form DPM-1, Physician's Questionnaire Form DPM-60 and Your Resume.
You are required to submit Form DPM-60, which is to be completed, signed and dated, by your physician.
Veterans with a disability rating of 10% or more from the VA may send a copy of your VA Rating Decision Letter in lieu of Form DPM-60. The letter must include both the rating and the diagnosis of your disability.
If you have a learning disability, you must submit a copy of your most recent psychological testing, in lieu of Form DPM-60.
If you are legally blind, you may submit a certificate of legal blindness, in lieu of Form DPM-60.
A copy of Form DPM-60 is attached to this application.
Common mistake: Your application will not be processed until the proper medical documentation is received.
Failure to include the Physician's Questionnaire or the VA Rating Decision letter with your application, or insufficient medical documentation, will slow down the review of your application.
You may be requested to provide additional medical documentation to determine eligibility, if needed.
A filled-in Form DPM-1 example: a veteran applies with a VA letter
How to fill out Form DPM-1, box by box
Your name, address, email, phone, counties and present employer
Enter your Last Name, First Name, MI and Social Security Number.
Enter your Mailing Address: No., Street, Apt., or P.O. Box, and your City, State and Zip Code.
Enter your Email Address and Day Phone.
Under What counties are you willing to work in, write the counties, and enter your Present Employer.
Signing and the date
You affirm under penalties of perjury that all statements made on this application (including any attached papers) are true.
You understand that all statements made by you in connection with this application are subject to investigation and verification and that a material misstatement or fraud may disqualify you from appointment and/or lead to revocation of your appointment.
Sign on the Signature of Applicant line, enter the Date (mm/dd/yyyy), and print any other name by which you are or have been known.
Service in the Armed Forces of the United States
Check YES or NO: Do you expect to receive or have you already received a discharge which was honorable or release under honorable circumstances from the Armed Forces of the United States?
The "Armed Forces of the United States" means the Army, Navy, Marine Corps, Air Force and Coast Guard, including all components thereof, and the National Guard when in the service of the United States pursuant to call as provided by Law, on a full-time active duty basis other than active duty for training purposes.
Check YES or NO: Do you have a service connected disability rated at 10% or more by the U.S. Department of Veterans Affairs?
Check YES or NO: Are you in possession of a letter from the Department of Veterans' Services that restores access to state benefits pursuant to the Restoration of Honor Act?
Your education
Check Yes or No for Do you have a High School or Equivalency Diploma? If YES, write the name and location of High School or Issuing Governmental Authority.
For each College, University, Professional or Technical School(s), enter the Name, Address, City and State, Semester Credits Received or Quarter Hours Received, Type of Degree Received and Major Subject or Type of Course, mark Yes or No under Did You Graduate and enter the Degree Expected (MO. YR.).
License or certification
Complete the following if a license, certificate or other authorization to practice a trade or profession is required.
If you are not currently licensed check this box.
Enter the Trade or Profession, License Number and Date License First Issued, and under Registration enter From and To (MO. / YR.).
Enter the Specialty, Granted by (licensing agency), City and State.
Describe your experience
Beginning with your most recent, list all employment, military service, or volunteer experience.
Under DUTIES, describe the nature of the work which you personally performed, including the estimated percentage of time spent on each type of activity.
If you supervised, state how many people and the nature of such supervision.
Enter the Length of Employment (MO. / YR. From and To), Firm Name, Address, City and State, Duties, Type of Business, Your Exact Title, Name of Your Supervisor, Supervisor's Title and the No. of hours worked per week (exclusive of overtime).
Physician's Questionnaire, Form DPM-60
Documentation submitted to establish your medical eligibility for appointment consideration under Sections 55-b/c of the Civil Service Law must be current and must include the following information.
Please have your Physician complete this Questionnaire.
In some cases, you may need to attach additional documentation.
Enter the Name and Social Security Number.
The Medical Provider enters the Printed/ Typed Name and the Professional License Type and # and State, the Medical Provider Signature and Date.
More rules for Form DPM-1
Failure to provide the information on this application may result in an inability to process your application.
Veterans
You are a Veteran
If you are a Veteran, your application must also include a copy of your DD-214 paperwork and ROHA letter*. *If you are a ROHA recipient and are unable to produce a VA Rating Decision letter, please provide a statement from your medical provider describing your disability and stating that your disability is connected to your military service.
Common questions about Form DPM-1
What is NYS 55B?
Form DPM-1 is the application for the New York State Governor's Program to Hire Persons with Disabilities under Sections 55-b and 55-c of the Civil Service Law. This is an application for the Governor's Programs to Hire Persons with Disabilities: the 55b and 55c Programs.
What is 55b c eligibility nys?
Placement pursuant to Sections 55-b and 55-c of the Civil Service Law is limited to persons with physical or mental disabilities, but who are found otherwise qualified to perform satisfactorily the duties of a position.
Where do I file it?
Send the completed application to the New York State Department of Civil Service 55b/c Program, Albany, NY 12239.
Where to get help with Form DPM-1
If you have questions or concerns, the Office of Diversity and Inclusion Management 55-b/c Program can be reached at 518-473-8961 or toll-free at 1-866-297-4356.
Sources
[1] Application packet for the Governor's Programs to Hire Persons with Disabilities (Form DPM-1, 2/2026 L, and Form DPM-60, 4/2026 L), New York State Department of Civil Service (the Official source link on this page).