Common use of To the Consultant Reporting Section of the Bureau of Contracts at OSC Clause in Contracts

To the Consultant Reporting Section of the Bureau of Contracts at OSC. By mail: NYS Office of the State Comptroller Bureau of Contracts 000 Xxxxx Xxxxxx, 00xx Xxxxx Xxxxxx, XX 00000 Attn: Consultant Reporting By fax: (000) 000-0000 or (000) 000-0000 By mail: NYS Department of Civil Service ESP, Agency Building 0 00xx Xxxxx Xxxxxx, XX 00000 State Agency Department ID: 3050000 Agency Business Unit: OSC01 Contractor Name: Contract Number: Contract Start Date: / / Contract End Date: / / Employment Category Number of Employees Number of hours to be worked Amount Payable Under the Contract 29-1069.00 Physicians and Surgeons, All other Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Report Period: April 1, to March 31, Contract Number: Agency Business Unit: OSC01 Contract Term: / / to / / Agency Department ID: 3050000 Contractor Name: Contractor Address: Description of Services Being Provided: Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting Employment Category Number of Employees Number of Hours Worked Amount Payable Under the Contract Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Allergy Cardiology Dermatology Endocrinology Gastroenterology General Surgery Gynecology Hematology Immunology Infectious Disease Internal Medicine/Family Medicine Nephrology Neurology Neurosurgery Oncology Ophthalmology Oral Surgery Orthopedics Orthopedic Surgery Otolaryngology Plastic Surgery Pulmonology Rheumatology Toxicology Urology Vascular Surgery $1,200.00 • Psychiatry $1,400.00 • Psychiatry (additional examination) $400.00 • Neuropsychiatry $2,000.00 • Neuropsychology $2,500.00 • Cancellation or rescheduling of an IME within 48 hours of scheduled IME (includes no- shows) $500.00 • Review of records in excess of 200 pages (per page) $1.00 • Review of records (without performing IME, up to 200 pages) $300.00 • Review of records (without performing IME, in excess of 200 pages, per page) $1.00 • Supplemental Report (only if such report is not required to clarify the original Report). No new records will be submitted $150.00 • Supplemental Report including up to 50 pages of new record review $200.00 • Supplemental Report (in excess of 50 pages, per page) $1.00

To the Consultant Reporting Section of the Bureau of Contracts at OSC. By mail: NYS Office of the State Comptroller Bureau of Contracts 000 Xxxxx Xxxxxx, 00xx Xxxxx Xxxxxx, XX 00000 Attn: Consultant Reporting By fax: (000) 000-0000 or (000) 000-0000 By mail: NYS Department of Civil Service ESP, Agency Building 0 00xx Xxxxx Xxxxxx, XX 00000 State Agency Department ID: 3050000 Agency Business Unit: OSC01 Contractor Name: Contract Number: Contract Start Date: / / Contract End Date: / / Employment Category Number of Employees Number of hours to be worked Amount Payable Under the Contract 29-1069.00 Physicians and Surgeons, All other Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Report Period: April 1, to March 31, Contract Number: Agency Business Unit: OSC01 Contract Term: / / to / / Agency Department ID: 3050000 Contractor Name: Contractor Address: Description of Services Being Provided: Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting Employment Category Number of Employees Number of Hours Worked Amount Payable Under the Contract Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Allergy Cardiology Dermatology Endocrinology Gastroenterology General Surgery Gynecology Hematology Immunology Infectious Disease Internal Medicine/Family Medicine Nephrology Neurology Neurosurgery Oncology Ophthalmology Oral Surgery Orthopedics Orthopedic Surgery Otolaryngology Plastic Surgery Pulmonology Rheumatology Toxicology Urology Vascular Surgery $1,200.00 • Psychiatry $1,400.00 • Psychiatry (additional examination) $400.00 • Neuropsychiatry $2,000.00 • Neuropsychology $2,500.00 • Cancellation or rescheduling of an IME within 48 hours of scheduled IME (includes no- shows) by the Member $500.00 • Review of records in excess of 200 pages (per page) $1.00 • Review of records (without performing IME, up to 200 pages) $300.00 • Review of records (without performing IME, in excess of 200 pages, per page) $1.00 • Supplemental IME Report (only if such report is not required to clarify the original IME Report). No new records will be submitted $150.00 • Supplemental IME Report including up to 50 pages of new record review $200.00 • Supplemental IME Report (in excess of 50 pages, per page) $1.00

To the Consultant Reporting Section of the Bureau of Contracts at OSC. By mail: NYS Office of the State Comptroller Bureau of Contracts 000 Xxxxx Xxxxxx, 00xx Xxxxx Xxxxxx, XX 00000 Attn: Consultant Reporting By fax: (000) 000-0000 or (000) 000-0000 By mail: NYS Department of Civil Service ESP, Agency Building 0 00xx Xxxxx Xxxxxx1 20th Floor Albany, XX 00000 NY 12239 State Agency Department ID: 3050000 Agency Business Unit: OSC01 Contractor Name: Contract Number: Contract Start Date: / / Contract End Date: / / Employment Category Number of Employees Number of hours to be worked Amount Payable Under the Contract 29-1069.00 Physicians and Surgeons, All other Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Report Period: April 1, to March 31, Contract Number: Agency Business Unit: OSC01 Contract Term: / / to / / Agency Department ID: 3050000 Contractor Name: Contractor Address: Description of Services Being Provided: Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting Employment Category Number of Employees Number of Hours Worked Amount Payable Under the Contract Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Allergy Cardiology Dermatology Endocrinology Gastroenterology General Surgery Gynecology Hematology Immunology Infectious Disease Internal Medicine/Family Medicine Nephrology Neurology Neurosurgery Oncology Ophthalmology Oral Surgery Orthopedics Orthopedic Surgery Otolaryngology Plastic Surgery Psychiatry Pulmonology Rheumatology Toxicology Urology Vascular Surgery Cardiology Dermatology Endocrinology Gastroenterology $1,200.00 • Psychiatry $1,400.00 1,500.00 General Surgery Gynecology Immunology • Psychiatry (additional examination) $400.00 • Neuropsychiatry $2,000.00 • Neuropsychology $2,500.00 • Hematology/Oncology $3,000.00 • Cancellation or rescheduling of an IME within 48 hours of scheduled IME (includes no- shows) $500.00 • Review of records in excess of 200 pages (per page) $1.00 • Review of records (without performing IME, up to 200 pages) $300.00 • Review of records (without performing IME, in excess of 200 pages, per page) $1.00 • Supplemental IME Report (only if such report is not required to clarify the original Report). No new records will be submitted $150.00 • Supplemental IME Report including up to 50 pages of new record review $200.00 • Supplemental IME Report (in excess of 50 pages, per page) $1.00

To the Consultant Reporting Section of the Bureau of Contracts at OSC. By mail: NYS Office of the State Comptroller Bureau of Contracts 000 Xxxxx Xxxxxx, 00xx Xxxxx Xxxxxx, XX 00000 Attn: Consultant Reporting By fax: (000) 000-0000 or (000) 000-0000 By mail: NYS Department of Civil Service ESP, Agency Building 0 00xx Xxxxx Xxxxxx1 20th Floor Albany, XX 00000 NY 12239 State Agency Department ID: 3050000 Agency Business Unit: OSC01 Contractor Name: Contract Number: Contract Start Date: / / Contract End Date: / / Employment Category Number of Employees Number of hours to be worked Amount Payable Under the Contract 29-1069.00 Physicians and Surgeons, All other Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Report Period: April 1, to March 31, Contract Number: Agency Business Unit: OSC01 Contract Term: / / to / / Agency Department ID: 3050000 Contractor Name: Contractor Address: Description of Services Being Provided: Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting Employment Category Number of Employees Number of Hours Worked Amount Payable Under the Contract Total this page 0 0 $ 0.00 Name of person who prepared this report: Title: Phone #: Preparer's Signature: Date Prepared: / / (Use additional pages, if necessary) Page of Allergy Cardiology Dermatology Endocrinology Gastroenterology General Surgery Gynecology Hematology Immunology Infectious Disease Internal Medicine/Family Medicine Nephrology Neurology Neurosurgery Oncology Ophthalmology Oral Surgery Orthopedics Orthopedic Surgery Otolaryngology Plastic Surgery Pulmonology Rheumatology Toxicology Urology Vascular Surgery $1,200.00 • Psychiatry $1,400.00 • Psychiatry FORM AC3322 Article 3 of the Veterans’ Services Law seeks to encourage and support eligible service-disabled veteran- owned businesses (additional examinationSDVOBs) $400.00 • Neuropsychiatry $2,000.00 • Neuropsychology $2,500.00 • Cancellation or rescheduling to play a greater role in the State's economy by providing for meaningful participation in New York State's contracting opportunities. It is the policy of an IME within 48 hours the Office of scheduled IME the State Comptroller (includes no- showsOSC) $500.00 • Review to make every effort to use SDVOBs in accordance with State laws in the purchasing and contracting activities of records in excess of 200 pages (per page) $1.00 • Review of records (without performing IME, up to 200 pages) $300.00 • Review of records (without performing IME, in excess of 200 pages, per page) $1.00 • Supplemental Report (only if such report is not required to clarify the original Report). No new records will be submitted $150.00 • Supplemental Report including up to 50 pages of new record review $200.00 • Supplemental Report (in excess of 50 pages, per page) $1.00OSC.