For substitutions, item C must also be completed.
Copy: a copy of this form must be sent to the workers' compensation insurance carrier, self-insured employer or employer (see section E above).
Health providers: send a copy of this form to all of the claimant's health providers, if applicable.
Filing: an attorney or licensed representative shall file a notice of retainer and appearance immediately upon being retained.
Photocopy: a photocopy of this notice shall be deemed as effective as an original.
Claimant's signature: ink only; use blue ink if possible.
| Question | Answer |
|---|---|
| Form Name | OC-400 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 67 |
| Avg. time to fill out | 12 min |
| Edition | 1-23 |
| Issuing agency | State of New York Workers' Compensation Board |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | OC-400, OC400, OC 400, Notice of Retainer and Appearance, Notice of Substitution and Appearance |
| Official source | OC-400 (Rev 1-23), State of New York Workers' Compensation Board |
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