Fillable Asbestos Safety Training Equivalency/Reciprocity Application (New York)

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Asbestos Safety Training Equivalency/Reciprocity Application (New York)

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Guidance for Applying for Equivalency/Reciprocity:
All individuals who need a New York State Department of Labor (DOL) asbestos certificate to work on asbestos projects in New York State must
first receive appropriate training from a New York State Department of Health (DOH) approved asbestos training provider or submit documentation
to the DOH for a determination that they have completed equivalent training. This guidance document explains the equivalency application
process as required by Title 10, Part 73 of the New York State Codes, Rules and Regulations (NYCRR) to obtain a DOH Certificate of Asbestos
Safety Training (DOH-2832). Applicants should apply to this Department following the steps below. Please contact us if you do not fit these
categories/prerequisites. Allow up to four weeks for processing.
If you have attended Non-New York State training:
1. Submit a notarized ASBESTOS TRAINING EQUIVALENCY/RECIPROCITY APPLICATION (DOH-4353) – See reverse.
2. Submit proof of initial and all subsequent refresher training for each discipline you are applying for. This may include information such as:
course completion certificates, diplomas or state issued training completion certificates (i.e., New Jersey ASB-24). In accordance with Federal
(40 CFR Part 763) asbestos accreditation requirements, a lapse of more than 2 years between specific training courses will result in denial
of your request. If you have a lapse of more than 2 years, you are required to take a initial course of training in order to certify and work
in New York.
3. Submit a photocopy of your most current state issued asbestos license(s) and/or certificate(s).
4. Submit a photocopy of valid government issued identification.
5. Your information will be reviewed and you will be notified if additional information is needed.
6. You will be notified in writing of approval or denial. Denied applicants will receive reason for denial. If you are approved, you must complete a
NYS approved refresher training course. Instructions will be provided in your approval letter.
7. After you have successfully completed a NYS approved refresher training course, you will be issued a DOH Certificate of Asbestos Safety
Training (DOH-2832) by the NYS DOH.
8. The DOH-2832 certificate must be submitted to the New York State Department of Labor when applying for certification. For questions on
the New York State Department of Labor certification process, call (518) 457-2735 or visit their website at: www.labor.ny.gov.
If you are a New York State Approved Instructor:
1. Submit a notarized ASBESTOS TRAINING EQUIVALENCY/RECIPROCITY APPLICATION (DOH-4353) – See reverse.
2. Submit the approved course roster(s) and course agenda(s) indicating the subject matter that you presented demonstrating that you provided
instruction for all course topics. If you did not instruct the course in its entirety or if there is lapse of more than 2 years between specific
training courses, your application will be denied. If you did not instruct a course in its entirety, you may reapply when you do. If you have a
lapse of more than 2 years, you may reapply if you instruct an initial course in its entirety.
3. Submit the Asbestos Course Attendance Roster (DOH-4427) for the courses you instructed, corresponding to the course agenda/discipline for
which you are seeking an equivalency.
4. Your information will be reviewed and you will be notified if additional course documentation or information is needed.
5. You will be notified in writing of approval or denial. Denied applicants will receive reason for denial.
6. If approved, you will be issued a DOH Certificate of Asbestos Safety Training (DOH-2832).
7. The DOH-2832 certificate must be submitted to the New York State Department of Labor when applying for certification. For questions on the
New York State Department of Labor certification process call (518) 457-2735 or visit their website at: www.labor.ny.gov.
For additional information on the DOH equivalency process please contact us at (518) 402-7940.
Asbestos Safety Training
Equivalency/Reciprocity Application
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Occupational Health and Injury Prevention
DOH-4353 (9/13) Page 1 of 2
Asbestos Safety Training
Equivalency/Reciprocity Application
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Occupational Health and Injury Prevention
DOH-4353 (9/13) Page 2 of 2
SECTION 2. APPLICATION BASED ON
SECTION 3. DISCIPLINES REQUESTED (check all that apply)
City/Town
NYS Department of Motor Vehicles Identification Number (optional) Social Security Number (optional)
County State Zip Code Phone Number
SECTION 1. APPLICANT INFORMATION
Last Name First MI
Address Number and Street Name Apt #
Non-NYS Training NYS Approved Asbestos Instructor
Handler / Worker
Inspector
Project Monitor
Contractor / Supervisor
Project Designer
Management Planner
Air Sampling Technician
Allied Trades
Operations and Maintenance
SECTION 4. COMPANY or OTHER CONTACT INFORMATION (optional)
Please send my determination to the entity below.
Please check the box and complete the information below if you want your determination sent to someone other than yourself.
SECTION 5. ATTESTATION and NOTARY
Last Name First MI Company Name
Address Number and Street Name Suite/Apt #
I have read the attached “Asbestos Safety Training Equivalency/Reciprocity Guidance” (Page 1) and I understand that the New York State
Department of Health may contact training providers or my employer to review the asbestos training that I have received or have instructed.
I have attached all training certificates, copies of all the other state licenses/certificates or other documentation. I attest that I have completed/
conducted training in accordance with applicable State and Federal asbestos regulations:
New York State Department of Health Asbestos Safety Training Program
Corning Tower, Room 1325
Empire State Plaza
Albany, NY 12237
Attn: Equivalency Application
Please mail your application to:
(Faxed requests will not be accepted)
Sworn before me this day of , 20
Signature Date
Notary Public
City/Town County State Zip Code Phone Number
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Asbestos Safety Training EquivalencyReciprocity Application (New York)

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Completed 21 July 2020

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