N.Y. Comp. Codes R. & Regs. tit. 15 § 135.6
Included in an application for a restricted use license shall be a waiver by the applicant. No person shall be issued a restricted license unless a waiver signed by the applicant is filed with the department. Such waiver must contain a statement that a driving license is a necessary incident to the applicant's employment, business, trade, occupation, profession or education, or en route to or from a medical examination or treatment as part of a necessary medical treatment for such applicant or member of his or her household, as evidenced by a letter to that effect from a licensed medical practitioner, and that the denial of a license would deprive the applicant of his or her usual means of livelihood and would constitute an unwarranted and substantial hardship on the applicant and such applicant's immediate family, or would seriously impair such person's ability to meet the requirements of his education by prohibiting his travel to and from a class or course at an accredited school, college or university or at a State-approved institution of vocational or technical training, and shall provide that the applicant agrees:
N.Y. Comp. Codes R. & Regs. Tit. 15 § 135.6