Application by a duly licensed psychologist of the State of New York to practice under the Workers' Compensation Law shall be made upon a form furnished by the chair and shall be filed with the Psychology Practice Committee, Workers' Compensation Board, Health Provider Administration, 100 Broadway-Menands, Albany, NY 12241. Such application shall state, fully and truthfully, all the information required by law, and the applicant shall make and sign the statutory agreement. The chair shall notify the psychologist of approval of his or her application within 60 days after receipt by the chair of a recommendation for approval from the Psychology Practice Committee.