Certificate of Relief Process and Forms

If you have or may be disqualified from possessing a firearm pursuant to the federal Brady Act as a result of being committed to a mental institution or adjudicated as having a mental disability, and your records were submitted to the National Instant Criminal Background Check System by the Office of NICS Appeals and SAFE Act, you may apply to the office for a Certificate of Relief from Disabilities pursuant to New York State Mental Hygiene Law Section 7.09(j). A determination as to whether or not to grant a Certificate of Relief is based on whether or not a person's record and reputation are such that he/she will not be likely to act in a manner dangerous to public safety and granting the relief would not be contrary to the public interest.

Application Requirements

To apply for the Certificate of Relief, you must complete the application and submit it to Office of NICS Appeals and SAFE Act.

In addition to the forms provided, you must submit the following information:

A copy of your social security card; birth certificate and driver’s license with current address;

True and certified copies of medical records detailing your psychiatric history over the past 20 years, which shall include the records pertaining to the commitment to a mental health facility, or adjudication as having a mental disability, which is the subject of the request for relief;

True and certified copies of medical records from all of your current treatment providers over the past 5 years, if you are receiving treatment;

True and certified records from any previous alcohol/substance abuse providers over the past 20 years;

A true and certified copy of all criminal history information maintained on file at the New York State Division of Criminal Justice Services (DCJS) and the Federal Bureau of Investigation (FBI) pertaining to you, or a copy of a response from DCJS and the FBI indicating that there is no criminal history information on file. To obtain a certified copy of your New York State criminal history information, you must call the DCJS Record Review Unit at (518) 485-7675, or go to the DCJS Record Review web site

To obtain a certified copy of your criminal history information from the Federal Bureau of Investigation please visit the FBI website.

The Federal Bureau of Investigation will require a signed cover letter, provided by the FBI, along with proof of identity (set of fingerprints) and payment to be sent to:

FBI CJIS Division – Record Request
1000 Custer Hollow Road
Clarksburg, West Virginia 26306.

You must allow approximately 16-18 weeks for processing, upon receipt by the FBI. Either a no record response or a FBI Identification Record will be mailed to you.

Evidence of your reputation, which may include notarized letters of reference from current and past employers, family members or personal friends, affidavits, or other character evidence;

Any further information specifically requested by the Office of NICS Appeals and SAFE Act. If documents are requested, certified copies of original documents must be provided. After you submit your completed application, we will notify you if additional information will be requested.

You may provide a psychiatric evaluation performed no earlier than 90 calendar days from the date that you are submitting the request for this certificate of relief, conducted by a “qualified psychiatrist.” A “qualified psychiatrist” is a physician licensed to practice medicine in New York State who is a diplomat of the American board of psychiatry and neurology or is eligible to be certified by that board, or is certified by the American osteopathic board of neurology and psychiatry or is eligible to be certified by that board. Please inform the “qualified psychiatrist” that this evaluation must include an opinion as to whether or not your record and reputation are such that you will or will not be likely to act in a manner dangerous to public safety and whether or not the granting of the relief would be contrary to the public interest.

Whether or not you provide a psychiatric evaluation, the office may also request that you undergo a clinical evaluation and risk assessment. If we make this request, the evaluation must be performed 45 calendar days from the date we request the evaluation, unless we allow an extension of time.

It is Your responsibility to ensure that all required information accompanies this request when you submit it to the Office. Information provided after our receipt of the completed application for relief will not be considered. If we request additional information, it is Your responsibility to provide it in accordance with our request. Information specifically requested by us must be received within 60 days of the date requested in accordance with our request. Information specifically requested by us must be received within 60 days of the date requested in order for it to be considered. Failure to meet these time frames will result in a denial of the certificate of relief.