Filing Statement Due March 1, 2016
Revised Code section 4753.12(A) requires each organization
that employed a licensed individual in the practice of
speech-language pathology and audiology during calendar
year 2015 to complete and submit a Business Filing Form
by March 1, 2016. Forms will be mailed to organizations
at the end of January. Forms may also be downloaded by
clicking on the appropriate link below. There is no fee
to submit the statement.
an effort to reduce paper and support the "Go Green"
campaign, the Board now accepts electronic copies of the
completed form. Electronic copies of this form, including
any attachments, are preferred and may be submitted to
the Board via e-mail at firstname.lastname@example.org.
You may also submit your completed form via fax at (614)
485-1029. The original statement does not need to be mailed
to the board office and may be retained for your records.
regarding the Business Filing Statement
Do I need to contact the Board to request an extension
if my filing statement is not submitted by the deadline?
No, If you need additional time to submit your business
filing statement, you do not need to contact the Board
to request an extension. Please submit your statement
electronically as soon as you complete it. There is no
penalty for submitting the form after March 1, 2016.
After I submit the business filing statement, will I receive
another communication from the Board?
Yes, after review of your business filing statement, the
Board will send an acknowledgement to the individual who
prepared the statement via e-mail. Please include your
e-mail address on the form.
I am an audiologist or speech-language pathologist with
a solo-practice. Am I required to submit a business filing
No, if you are a licensee with a solo practice and do
not employ any other licensees who engage in the practice
of speech-language pathology or audiology, you are not
required to submit a business filing statement. If you
received a business filing statement, you may disregard
I am licensed physician and employ licensed individuals
who engage in the practice of speech-language pathology
and audiology. Am I required to submit a business filing
No, an individual licensed pursuant to Chapter 4731 of
the Revised Code who employs or contracts individuals
in the direct practice of speech-language pathology or
audiology is not required to submit a business filing.
Are healthcare entities required to file a business filing
Yes, medical entities, including but not limited to, hospitals,
clinics, medical partnerships, medical corporations, speech-language
pathology and audiology contracting agencies, which employ
or contract individuals in the direct practice of speech-language
pathology or audiology, are required to submit a business
I am a speech-language pathologist or audiologist and
my employer forwarded the business filing form to me to
complete; however, I do not maintain my employer's personnel
information. Should I still complete the form?
No, if this form is routed to the individual licensee
by their employer, the form should be forwarded to the
Human Resource/Administrative Department, where the personnel
records for all employees who practiced speech-language
pathology or audiology during 2015 are maintained.
you have any questions regarding the Business Filing Statement,
please contact the Board office at (614) 728-2214 or email
your question to email@example.com.