What Form 4B is
When you apply for the LCSW in New York, you list every supervised experience on Form 4. Then each supervisor certifies their part on Form 4B: the setting, the period they supervised you, and your client-contact and supervision hours in that period. NYSED uses them to check that you met the 2,000 client-contact hours, 100 hours of supervision and at least 36 months the LCSW requires.
Who fills in what
- You complete your section, then send each supervisor their Form 4B with a copy of Appendix A
- Each supervisor completes their section, including their license and the setting’s documentation
- One Form 4B for each supervisor: two supervisors mean two forms
Who sends it to NYSED
Your supervisor, directly to NYSED, by email or by mail. NYSED does not accept Form 4B from the applicant, so the part you control is getting each supervisor a complete, correct form, early.
Special cases
- Your supervisor has died: another LCSW may complete Form 4B, giving your original supervisor’s qualifications and the dates and frequency of supervision. A dated weekly record makes this possible.
- Supervision outside New York: that supervisor also submits Form 4Q, so NYSED can review their qualifications.
- Your supervisor and setting, before you start: optional Form 6 ($10) lets NYSED review them before your hours begin; it is not reviewed once the experience is complete.
NYSED’s forms
Form 4 (PDF) (opens in a new tab)Form 4B (PDF) (opens in a new tab)Appendix A (opens in a new tab)
Form 4B, filled in from your record
Licensure Hours keeps your weekly hours as you go and has your supervisor confirm them with a link. When you apply, it fills in Form 4B from your record, one per supervisor, stating which weeks they confirmed, and drafts the email that sends it to them. Free for 30 days, no card.