In short
A free weekly sheet for your supervised hours toward the New York LMHC, on one printed page or as a spreadsheet. It is a suggested log, not an official form: NYSED publishes none. It splits your hours into direct client contact, other indirect hours and supervision, which add up to the total hours practicing that Form 4B asks your supervisor to certify.
On this page6 sections
A suggested log, not an official form. NYSED publishes no log form. These columns follow 8 NYCRR 79-9.3 and what the MHC Form 4B (Rev. 10/24) asks your supervisor to certify.
NY LMHC hours log
- Your name:
- Name of supervisor:
- Supervisor's license: professional title, number and jurisdiction:
- Agency or practice name:
- Agency or practice address:
- Dates of experience: from and to:
| Week of | Direct client contact hours | Indirect hours other than supervision (recordkeeping, case management, research, professional development) | Supervision hours (individual or group) | Total hours practicing mental health counseling | Supervisor's initials |
|---|---|---|---|---|---|
| Total |
Supervision is indirect time too; it has its own column, so don't write it twice. The total adds direct, indirect and supervision.
One log per supervisor and setting: each Form 4B covers one supervised experience. Your supervisor keeps the documentation NYSED may ask for (8 NYCRR 79-9.3).
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
- Direct client contact hours
- Indirect hours other than supervision: recordkeeping, case management, research and professional development
- Supervision hours, individual or group. Supervision is indirect time too; it has its own column, so don't write it twice
- The total: direct, indirect and supervision together
- Your supervisor's initials
What NYSED counts
3,000 hours of supervised experience, of which “Not less than 1,500 clock hours ... shall consist of direct contact with clients” (8 NYCRR 79-9.3); Appendix A adds “or one-half of the hours in any setting”. Your supervisor attests on Form 4B to supervising you “for at least one hour per week or two hours every other week”.
Who keeps the official record
Your supervisor: “The supervisor is responsible for maintaining documentation of the applicant's supervised practice and hours of supervision, and for submitting a copy of such documentation to the Department upon its request” (8 NYCRR 79-9.3). Form 4B asks for the dates of your experience and the total hours practicing mental health counseling. Keep one sheet for each supervisor and setting.
Sources
- 8 NYCRR Subpart 79-9, mental health counseling (opens in a new tab)
- NYSED MHC Form 4B (PDF, Rev. 10/24) (opens in a new tab)
- NYSED: LMHC Appendix A, supervised experience (opens in a new tab)
More on the free hours logs
- Free printable hours logs for the LCSW, LMHC and LMFT
- NY LCSW 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: