New York State Department of Motor Vehicles TVB TICKET MANAGEMENT FOR ATTORNEYS APPLICATION FOR WEB ACCESS This form is available to be downloaded from the DMV public website - www.dmv.ny.gov WHAT IS “TVB Ticket Management for Attorneys”? A web application that allows attorneys to schedule hearings online for clients’ traffic tickets answerable in Traffic Violations Bureau (TVB) offices. This web application cannot be used to schedule any other type of hearing. WHO MAY HAVE ACCESS? Only attorneys, currently licensed to practice law in New York State, who abide by the Terms of Use as set forth herein may use the TVB Ticket Management for Attorneys web application. A New York State Department of Motor Vehicles (DMV) web access account is required to access this web application. INSTRUCTIONS FOR COMPLETING THIS APPLICATION: 1. Complete the Applicant information, Section I (Please type or print legibly). 2. Read the Terms of Use, Section II, and sign and date the Certification, Section III, agreeing to the Terms of Use (Use black or blue ink). 3. Attach a photocopy of the face (photo side) of your driver license or non-driver identification card to this application (All information on the card must be legible in the photocopy). 4. Mail the original signed form and attachment to: Traffic Violations Division - Attorney Scheduling New York State Department of Motor Vehicles 6 Empire State Plaza, Room 213 Albany, NY 12228 The Department will not process your application unless you provide all required information and sign the certification. NOTE: Applicants who do not already have a web account with DMV will receive their new account User ID by e-mail, with their password sent separately, by regular mail, to the business address provided in Section I of this application form. Applicants who already have a web account with DMV will receive an e-mail notification advising them when access to the TVB Ticket Management for Attorneys web application is granted. AA-15 (2/11) PAGE 1 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com New York State Department of Motor Vehicles TVB TICKET MANAGEMENT FOR ATTORNEYS APPLICATION FOR WEB ACCESS This form is available to be downloaded from the DMV public website - www.dmv.ny.gov SECTION I A. Type of Request (Check only one): Original request Reactivation B. Your last name (not to exceed 20 characters) Optional Suffix (e.g., Jr, Sr, Esq., III.) C. first name D. middle name (if none, please leave this field blank) E. If changed, your last name at the time you were admitted to the Bar F. Your Office of Court Administration (OCA) Attorney Registration Number G. If you already have an account with DMV to access applications through Site Pass on the DMV website, you must provide your User ID. Examples of Site Pass applications include LENS, FINS, and Series Memos. (If you do not already have a Site Pass web account with DMV, please leave this field blank.) Your DMV Site Pass User ID H. Your complete e-mail address that you wish to use for your DMV web account (include the “@” and the periods). If you already have a web access account with DMV, write “U S E – C U R R E N T” in the boxes below. If you already have access and wish to change your current email address, provide the new e-mail address and check the box, below: Replace current e-mail address with: I. Your preference for receiving daily e-mails with updates and notices of changes to the status of your clients’ tickets and scheduled hearings; Check only one: One consolidated e-mail for all clients who had any update or change to tickets or hearings on that day (default) A separate e-mail for each client who had any update or change to tickets or hearings on that day J. Your Office Address: Building Number/ Street/Suite: K. City: L. State and ZIP code: M. The telephone number that you want DMV to use to contact you. Use the following format: (xxx) xxx-xxxx, ext. xxxx ( AA-15 (2/11) ) - , ext. PAGE 2 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com SECTION II - TERMS OF USE for TVB TICKET MANAGEMENT FOR ATTORNEYS It is expressly understood and agreed that access to the TVB Ticket Management For Attorneys web application is provided at the sole discretion of the Department of Motor Vehicles (“DMV”), and access may be withdrawn without notice in the event that DMV determines that any terms or conditions of use have been violated. DMV shall not be responsible for any omissions or errors in the information furnished to the attorney. The attorney does hereby waive all claims for damages arising from the use of the TVB Ticket Management For Attorneys web application. An attorney shall be permitted access to the TVB Ticket Management For Attorneys web application only for the purposes specified below and under the following terms and conditions: 1. The web application may be used only while the attorney is licensed to practice law in the State of New York; 2. Access to the information is provided solely for reviewing information about clients’ tickets, and scheduling or rescheduling hearings with Traffic Violations Bureau (“TVB”) offices for those tickets; 3. Access is limited to the attorney and his/her supervised support staff with the understanding that the attorney shall be responsible for all use of or access to the account; 4. If the undersigned attorney shares “personal information” obtained via the web application, which is defined in and protected under the Driver’s Privacy Protection Act (“DPPA”) (18 U.S.C. 2721, et seq.), with a recipient outside his/her organization, the attorney shall maintain a record of information identifying the recipient and specifying the recipients’ “permissible use”, as defined in the DPPA, for such information. S/He shall retain such record(s) FOR FIVE YEARS and shall make such records available to DMV, upon request, for audit purposes; 5. Under the Information Security Breach and Notification Act (“ISBNA”) (General Business Law, §899-aa; State Technology Law, §208), DMV is required to notify individuals if their records are accessed for unauthorized purposes. The attorney shall notify DMV in writing, within one (1) business day in the event the attorney becomes aware of a breach as defined in the ISBNA. The attorney shall defend, indemnify and hold harmless the DMV and its employees or agents from all claims, actions, damages, or losses, including the cost of any notifications required under the ISBNA, arising from the attorney’s negligent, improper, or unauthorized use or dissemination of information contained in DMV records. 6. In the event a client decides not to be represented by the attorney with respect to a particular ticket or tickets, after the attorney has already associated the client’s ticket or tickets to her/his account, then the attorney shall be required to disassociate such ticket or tickets from the attorney’s account within one (1) business day from receiving notice by the client. Failure to do so shall be treated as a breach of the terms hereof, and may result in DMV disassociating the client’s ticket or tickets from the account, and termination of access to this web application; 7. The attorney will not represent herself/himself as an agent or employee of DMV; 8. The Commissioner may terminate the undersigned attorney’s access to this web application at his/her discretion. Reasons for termination include, but are not limited to, false statements made by the attorney, concealment of material facts in connection with this application, or suspension or disbarment from the practice of law; 9. The attorney must notify DMV, in writing, within 30 days of any change in the information provided in connection with his/her application for any DMV web account. SECTION III- CERTIFICATION and ACKNOWLEDGEMENT OF TERMS OF USE I hereby declare, under penalty of perjury, that I am an attorney admitted to the practice of law, currently in good standing with the appropriate department of the Appellate Division of the Supreme Court of the State of New York. I agree to abide by the terms of use of the TVB Ticket Management For Attorneys web application as stated herein. Signature of Applicant: ________________________________________________________________ Date: _________________________ (Sign) SECTION IV- DMV OFFICE USE ONLY The above-named applicant’s access to TVB Ticket Management For Attorneys is hereby (check only one): Approved Disapproved for the following reason(s): Not listed in the OCA register Identity uncertain (information on the application does not match the photocopy of the driver license/ID Applicant blocked from having a VPASS account on ________________ by ________________________________________________________________________; __________________ (dd/mm/yy) (Printed Name) (Initials ) AA-15 (2/11) PAGE 3 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com