PSB-4

The Private Service Bureau Employee Roster (Form PSB-4) is a mandatory document issued by the New York State Department of Motor Vehicles (DMV) for businesses licensed to assist others with driver licenses, registrations, or titles. It serves as a comprehensive record of all individuals associated with a Private Service Bureau (PSB), including owners, partners, corporate officers, managers, and both paid and unpaid employees or agents. The form must be submitted to the DMV’s Partnering Programs unit whenever a new employee is hired or when an original or branch license application is filed, as failure to maintain an accurate roster can result in the suspension or revocation of the bureau's license.

The roster requires detailed personal and professional information, such as the individual's full name, the last four digits of their Social Security Number, and their employment history within the PSB industry. It includes a background disclosure section where applicants must report any previous license denials or revocations, criminal convictions, pending charges, or findings of professional misconduct. Both the employee and the business owner must sign the document, affirming the accuracy of the information under penalty of perjury and acknowledging that false statements are punishable as misdemeanors. Additionally, the submission must include a photocopy of the employee's valid driver license or non-driver identification card to verify their identity.