In short
A free weekly sheet for your supervised hours toward the New York LCSW, on one printed page or as a spreadsheet. It is a suggested log, not an official form: NYSED publishes none. Its columns follow what Form 4B asks your supervisor to certify for their period: client contact hours, the psychotherapy among them, and supervision hours.
On this page7 sections
A suggested log, not an official form. NYSED publishes no log form. These columns follow what Form 4B (Rev. 10/24) asks your supervisor to certify.
NY LCSW hours log
- Your name:
- Name of clinical supervisor:
- Supervisor's license (LCSW, psychologist or physician) and number:
- Name of setting:
- Setting address:
- Supervision period: starting and ending:
| Week of | Client contact hours: diagnosis, psychotherapy and assessment-based treatment plans | Of those, psychotherapy | Supervision hours, individual | Supervision hours, group | Supervisor's initials |
|---|---|---|---|---|---|
| Total |
One log per supervisor and setting: each Form 4B covers one supervisor's period.
Your supervisor keeps the record NYSED may ask for (8 NYCRR 74.6); this is your own copy.
Licensure Hours, licensurehours.com. Free to print and copy.
The printed page, in small. Print it full size, or use the spreadsheet.
What to write each week
- Client contact hours in diagnosis, psychotherapy and assessment-based treatment plans: the hours that count toward the 2,000
- Of those, the hours of psychotherapy: Form 4B asks your supervisor for the “Total number of client contact hours of psychotherapy”
- Supervision hours, individual and group
- Your supervisor's initials, so the two of you agree week by week
What NYSED counts
“Not less than 2,000 client contact hours of post-MSW supervised experience in diagnosis, psychotherapy and assessment-based treatment plans over a period of at least 36 months and no more than 6 years” (Form 4B), and at least 100 hours of individual or group clinical supervision, “distributed appropriately over the period” (8 NYCRR 74.6). Face-to-face supervision may be by secure video conferencing.
Who keeps the official record
Your supervisor: “The supervisor shall be responsible for maintaining records of the client contact hours ... and supervision hours” and gives them to NYSED on request (8 NYCRR 74.6). Form 4B asks your supervisor whether they kept that record, then for the dates, the total client contact hours of psychotherapy and the total supervision hours. This sheet is your own copy, and it makes those totals easy to agree on.
One sheet for each supervisor
Each Form 4B covers one supervisor's period at one setting, so start a new log when your supervisor or your job changes. The free PDF log has three years of pages with two to spare, a running total on every page, a page of totals by supervisor, and a contact card for each supervisor.
Sources
- NYSED LCSW Form 4B (PDF, Rev. 10/24) (opens in a new tab)
- 8 NYCRR Part 74, social work (opens in a new tab)
- NYSED: LCSW checklist (PDF, May 2025) (opens in a new tab)
More on the free hours logs
- Free printable hours logs for the LCSW, LMHC and LMFT
- NY LMHC hours tracking sheet: printable, and as a spreadsheet
- NJ LCSW hours tracking sheet: printable, and as a spreadsheet
- BBS Weekly Log of Experience Hours for AMFTs: a printable copy and CSV
Keeping your hours in Licensure Hours
Licensure Hours tracks New York LCSW, LMHC and LMFT, New Jersey LCSW and California LMFT hours today. It keeps your weekly hours, your supervisor confirms them by link, and it fills in your Form 4B from your record. Free for 30 days, no card.
Free PDF logs for New York’s licenses: