Please rate Form Oc 110A 2-26
This form is used when the requestor is not a party to the case.
Records request: this authorization does not generate a records request. Use form OC-RR to initiate a records request.
Witness: the witness's name and address must be completed. Requests with blank or incomplete witness fields will not be processed.
Parties: the claimant must initial for each party who will receive records.
Revoking: claimants may revoke this authorization at any time by submitting revocation in writing, which includes e-mail.
No limitations: if no limitations are indicated, the form will be considered to authorize the release of any and all information or records requested.
| Question | Answer |
|---|---|
| Form Name | OC-110A |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 21 |
| Avg. time to fill out | 4 min |
| Edition | 2-26 |
| Where to send | NYS Workers' Compensation Board, PO Box 5205, Binghamton, NY 13902-5205 |
| Who signs | The claimant (or the claimant's authorized representative) |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | OC-110A, OC110A, OC 110A, Form OC-110A, Claimant's Authorization to Disclose Workers' Compensation Information |
| Official source | OC-110A (Rev 2-26), |
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Please rate Form Oc 110A 2-26
