Indoor Tanning Permit Issuing Officials

The New York State Department of Health Herkimer District Office is responsible for the implementation of the Tanning Facility Program in:

• Fulton County
• Herkimer County
• Montgomery County

Permit Requirements

• DOH-3915: Application for a Permit to Operate (PDF)
• DOH-4494: Tanning Facilities Program Fee Determination Schedule (PDF)
• Tanning Facilities Program Application Checklist (PDF)
• Workers' Compensation and Disability Insurance Requirements for Obtaining a Department of Health Permit

Other Required Information and Forms

• Tanning Hazards Information Sheet
• Tanning Facility Statement of Acknowledgement Form
• Warning Sign, available in both English and Spanish in Portable Document Format (PDF). The sign must be printed 11" x 17" or larger to meet the text size requirements specified in the New York State regulation.
• Injury and Illness Report Form (PDF)

Contact Information

Download and complete forms DOH-3915, DOH-4494, and the Application Checklist and mail to:

New York State Department of Health
Herkimer District Office
5665 State Route 5
Herkimer, New York 13350-9721
(315) 866-6879