Fillable Printable Form AA-15 - TVB Ticket Management for Attorneys Application - New York

Form AA-15 - TVB Ticket Management for Attorneys Application - New York

AA-15 (2/15)

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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 Attorneysweb 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 424C

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.

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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 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:

J. Your Office Address: Building Number/ Street/Suite:

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

K. City:

M. The telephone number that you want DMV to use to contact you. Use the following format: (xxx) xxx-xxxx, ext. xxxx

L. State and ZIP code:

()

ext.

SECTION I

B. Your last name (not to exceed 20 characters)

A. Type of Request (Check only one):Original requestReactivation

C. first name

Optional Suffix (e.g., Jr, Sr, Esq., III.)

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

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

reset/clear

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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 Attorneysweb 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):

oApproved

oDisapproved for the following reason(s):

oNot listed in the OCA register

oIdentity uncertain (information on the application does not match the photocopy of the driver license/ID

oApplicant blocked from having a VPASS account

on ________________ by ________________________________________________________________________; __________________

(dd/mm/yy) (Printed Name)(Initials )

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.