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Request For Authorization To Use A General Vendor Helper - Nyc Department Of Consumer Affairs

REQUEST FOR AUTHORIZATION TO USE A

42 Broadway

New York, NY 10004

GENERAL VENDOR HELPER

Dial 311

(212-NEW-YORK)

You can request to use helpers to operate your business if you have a

“disability” that impairs your ability to operate your general vending business,

nyc.gov/dca

as described in Section 2-318 of Title 6 of the Rules of the City of New York.

Definitions:

Disability: a physical or mental impairment that substantially limits one or more

major life activities or major bodily functions and that permanently or

temporarily impairs an individual’s ability to operate a general vending

business.

Major life activities: include caring for oneself, performing manual tasks,

seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking,

breathing, learning, reading, concentrating, thinking, communicating, and

working.

Major bodily functions: include functions of the immune system, normal cell

growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory,

endocrine, and reproductive functions.

Applicant Name:

License Number

(if applicable):

Home Address:

I certify the following:

1. Please select the statement that describes you (check one box):

 I am a new applicant.

 I am a current licensee.

2. I have a disability that impairs my ability to operate my general vending

business and have attached the Certification of Licensed Health Care

Professional confirming this disability.

09/22/2016

Request For Authorization To Use A General Vendor Helper - Nyc Department Of Consumer Affairs