Free Texas 5506 Nar Form in PDF

Free Texas 5506 Nar Form in PDF

The Texas Nurse Aide Registry Form 5506-NAR, updated in September 2021, serves as an essential document for the employment verification process for nurse aides in Texas. It consists of two main sections: Section 1, which must be completed and signed by the nurse aide, and Section 2, which requires completion and notarization by the employer, to validate the nurse aide's employment and competency. To ensure your Certified Nurse Aide (CNA) certification remains active, follow the instructions carefully and submit the form to the Texas Nurse Aide Registry. Click the button below to fill out the form.

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The Texas Nurse Aide Registry Form 5506-NAR, updated in September 2021, serves as a critical component of maintaining accurate and up-to-date records for Nurse Aides in Texas. This form primarily functions to verify the employment status and history of a nurse aide, ensuring that they meet the necessary criteria for recertification, which includes being employed in a nursing or nursing-related service. Section 1 of the form requires detailed information from the Nurse Aide, including personal identification and certification details, along with declarations regarding any disqualifying misconduct or criminal convictions as outlined by Texas Health and Safety Code. It also asks the Nurse Aide to confirm the completion of required in-service education and training on infection control and the proper use of personal protective equipment (PPE) within the specified timeframe. Importantly, this information must be verified by the employer in Section 2, which also needs to be notarized to attest to its accuracy. The process underscores the importance of transparency and compliance in the healthcare sector, aiming to ensure that individuals entrusted with the care of others possess the requisite qualifications and maintain an ongoing commitment to professional development and ethical conduct. By requiring both self-certification and employer verification, the Texas Nurse Aide Registry seeks to uphold the high standards expected of healthcare providers and protect the welfare of patients.

Preview - Texas 5506 Nar Form

Texas Nurse Aide Registry

Form 5506-NAR

September 2021-E

Employment Verification

 

Section 1 (To be completed by Nurse Aide. Please read the following instructions before completing this form.)

Complete all information in Section 1 and sign to verify that the information provided is correct.

Obtain employer verification (Section 2). Form must be emailed to Texas Nurse Aide Registry at: nurseaideregistry@hhs.texas.gov. To verify your

Certified Nurse Aide (CNA) certification, use the following link: https://emr.dads.state.tx.us/DadsEMRWeb/.

Note: A list of approved in-service education programs can be found at: https://hhs.texas.gov/nar-cbts or https://hhs.texas.gov/nar-approved-inservice. The Texas Nurse Aide Registry will return (without action) incomplete requests and requests without the required documents.

Name of Applicant (Last, First, Middle):

Maiden Name (if applicable):

 

 

Mailing Address (Street or P.O. Box):

City:

Social Security No.:

Email Address:

State:

 

ZIP Code:

Daytime Phone No. with Area Code:

Sex:

 

Date of Birth:

CNA Certificate No.:

Male

Female

 

 

 

 

 

 

Verification of requirements for Nurse Aide Recertification

Are you listed on the Employee Misconduct Registry (EMR) as unemployable?

Yes

No

 

 

Have you been found to have a conviction of a criminal offense listed in Texas Health and Safety Code, §250.006?

Yes

No

If yes, give date of conviction.

 

 

 

 

 

 

 

 

 

 

Have you completed 24 hours of in-service education in the past two years?

Yes

No

 

 

Note: In-service education requirements are subject to audit. Be prepared to submit in-service certificates if contacted by Texas Health and Human Services Commission (HHSC).

Have you completed an HHSC course in infection control and proper use of personal protective equipment (PPE) once each year

Yes

No

in the past 24 months?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature – Nurse Aide

Date

 

 

Section 2 (To be completed by the Employer – Instructions)

This section must be completed by the facility program director, official keeper of records or actual employer.

Notarize employer signature at the bottom of this section and return to nurse aide.

Employer Name or Company Name:

Daytime Area Code and Phone No.:

Mailing Address (Street or P.O. Box):

City:

State:

ZIP Code:

I certify that the individual named above is/was employed by me as a nurse aide and performed nursing/nursing-related services from

to

 

 

and that I am not aware of any disqualifying misconduct.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature – Employer

 

 

 

 

Date

 

 

 

 

 

 

Sworn and subscribed to me on this

 

day of

, 20

, in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County, in the state of

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature – Notary Public

 

 

 

 

 

Date Commission Expires

 

 

Place Notary Seal or Stamp Here

 

Tampering with, or attempting to falsify, a government record such as a nurse aide certificate is a third-degree felony punishable by up to 10 years in prison and a $10,000 fine.

Form 5506-NAR

Page 2 / 9-2021-E

Address:

Did you sign and complete all information in Section 1?

Did your employer notarize his/her signature in Section 2?

Did you know?

You can verify certificate status by using the following link: https://emr.dads.state.tx.us/DadsEMRWeb/.

You can download forms from our website: https://hhs.texas.gov/doing-business-hhs/licensing-credentialing-regulation/nurse- aide-registry/nar-forms.

Email the completed form and required documents to the Texas Nurse

Aide Registry at nurseaideregistry@hhs.texas.gov

With a few exceptions, you have the right to request and be informed about the information that the Texas Health and Human Services Commission (HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please contact the Nurse Aide Registry at 512-438-2050.

Document Specs

Fact Name Description
Form Purpose The Texas 5506-NAR form is used for employment verification as part of the CNA certification or recertification process.
Sections There are two main sections: one to be completed by the Nurse Aide and another by the Employer.
Submission Email Completed forms must be emailed to nurseaideregistry@hhs.texas.gov.
Certificate Verification Link CNA certificate status can be verified at: https://emr.dads.state.tx.us/DadsEMRWeb/.
In-service Education Requirement Nurse Aides must complete 24 hours of in-service education every two years.
Infection Control Training A course in infection control and proper use of PPE must be completed once each year for the past 24 months.
Legal Consequences Falsifying this form is a third-degree felony, with penalties including up to 10 years in prison and a $10,000 fine.
Governing Law The form is governed by regulations set forth by Texas Health and Human Services Commission (HHSC).
Right to Information Individuals have the right to request and be informed about the information HHSC obtains about them.

Instructions on Writing Texas 5506 Nar

Completing the Texas 5506-NAR form is a vital step for nurse aides seeking to verify or recertify their certification with the Texas Nurse Aide Registry. This form helps ensure all necessary employment verification details are formally logged. To make this process as smooth as possible, it's essential to follow each step carefully, ensuring all information is accurate and complete before submission.

Steps for Completing the Texas 5506-NAR Form:

  1. Start by carefully reading the instructions provided in the form to fully understand the requirements and procedures.
  2. Fill in the "Name of Applicant" section with your last name, first name, and middle name. Include your maiden name if applicable.
  3. Enter your mailing address, including the street or P.O. Box number, city, state, and ZIP Code.
  4. Provide your Social Security Number in the space given.
  5. Add your email address and a daytime phone number, including the area code. This ensures the registry can reach you if further information is needed.
  6. Select your sex by marking either "Male" or "Female."
  7. Enter your date of birth and CNA Certificate Number in the respective fields.
  8. Answer the verification questions regarding your status on the Employee Misconduct Registry, any criminal offense convictions, completion of 24 hours of in-service education in the past two years, and whether you've completed an HHSC course in infection control and the proper use of personal protective equipment (PPE) once each year in the past 24 months.
  9. Sign and date the form in Section 1 to verify that all the information provided is accurate and correct to your knowledge.
  10. Have Section 2 completed by your employer, which includes the employer's name or company name, daytime phone number, mailing address, employment verification stating you've performed nursing or nursing-related services, and any comments they wish to add.
  11. Your employer must sign and notarize their signature at the bottom of Section 2.
  12. Before emailing the completed form and any required documents to nurseaideregistry@hhs.texas.gov, double-check all information for accuracy and completeness. Remember, incomplete requests or those without the required documents will be returned without action.

Once your form is submitted, it's crucial to stay informed about the status of your application. You can verify your certificate status using the link provided in the form instructions. Additionally, for future needs or any updates, remember that forms and further instructions are readily available for download from the Texas Health and Human Services website. Ensuring your information is correct and up-to-date not only complies with regulatory requirements but also fosters ongoing professional development in your career as a nurse aide.

Understanding Texas 5506 Nar

What is the purpose of the Texas 5506-NAR form?

The Texas 5506-NAR form serves a key role in verifying employment for nurse aides seeking certification or recertification. It ensures that nurse aides meet the state's health and safety standards, by confirming their employment status and verifying they have completed the required in-service education hours. Additionally, it checks for disqualifying misconduct and criminal convictions that could affect their certification.

How do I complete Section 1 of the form?

Completing Section 1 involves a few straightforward steps. First, provide all requested personal information accurately, including your name, contact details, and any applicable maiden name. Answer the questions about your employment status, in-service education completion, and criminal history. It's crucial to sign this section to attest to the truthfulness and accuracy of the information provided. Remember, incomplete or incorrect information can lead to the form being returned without action.

What are the requirements for the employer completing Section 2?

For Section 2, the responsibility lies with the employer or the official keeper of records. They must confirm the nurse aide's employment and clarify that the aide performed nursing-related services during the specified period. Importantly, the employer's signature must be notarized to validate the accuracy of the employment verification. This step is critical for ensuring the integrity of the certification process and must not be overlooked.

How do I submit the completed Texas 5506-NAR form?

Once both sections of the form are correctly filled out and signed, with the employer's signature duly notarized, the document is ready for submission. Email the completed form, along with any required documents, directly to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov. Ensure that all attachments are clear and legible to avoid delays in the processing of your certification or recertification.

Common mistakes

Filling out the Texas 5506-NAR form is a crucial step for Certified Nurse Aides (CNAs) in Texas seeking recertification, but it's easy to make mistakes. One common error is not completing all sections of the form. Section 1 is specifically designated for the nurse aide to fill out, yet often individuals submit their forms with incomplete information or overlook signing the document. This signature not only confirms the accuracy of the provided information but is also a mandatory requirement for processing the form.

Another frequent oversight is the failure to obtain employer verification in Section 2. This part of the form requires the employer's confirmation of employment, including specific details like employment duration and the performance of nursing-related services. It's critical for the employer to notarize their signature at the bottom of this section. Without this, the form is considered incomplete, leading to delays or rejection of the recertification request.

Many CNAs neglect the importance of clearly indicating their answers to the questions regarding their listing on the Employee Misconduct Registry, conviction of criminal offenses as stipulated by Texas Health and Safety Code, §250.006, completion of in-service education, and an HHSC course in infection control and proper use of personal protective equipment (PPE). Failing to answer these questions truthfully and accurately can result in severe consequences, including legal action.

Submitting the form without the required documents is another common mistake. The Texas Nurse Aide Registry mandates the inclusion of certain documents for processing the recertification. Overlooking this requirement will lead to the form being returned without action. This is a particularly unnecessary delay since the needed documents are outlined in the instructions.

Sending the form to the wrong email address can also be a crucial error. The form must be emailed to the nurseaideregistry@hhs.texas.gov address. Any deviation from this specified address means the form may not reach its intended destination, thereby stalling the recertification process.

Failure to utilize the available resources for verification and additional information is a missed opportunity. The form clearly provides a link for checking the status of a CNA certificate and where to find a list of approved in-service education programs. Ignoring these resources can result in inaccuracies or a lack of compliance with the recertification requirements.

Leaving out contact information or providing incorrect contact details in Section 1 can lead to communication issues. It is essential to provide a valid email address, phone number with the correct area code, and a mailing address to ensure any correspondence or notifications from the Texas Nurse Aide Registry reach the applicant promptly.

Last but not least, neglecting to request and review information obtained by the Texas Health and Human Services Commission (HHSC) about oneself is a overlooked right. Every applicant has the right to request and be informed about the information HHSC has on file. Failing to exercise this right could mean missing out on the chance to correct any inaccuracies that could affect the recertification outcome.

Documents used along the form

When individuals engage with the Texas Nurse Aide Registry through the Texas 5506-NAR form, it's often part of a larger process of certification, recertification, or verification within the healthcare sector. This process necessitates various forms and documents to ensure compliance, verify status, and maintain the integrity of the nurse aide's professional standing. Understanding these associated forms and documents can provide a clearer pathway for nurse aides navigating their certification or recertification.

  • Form 5505-NAR: Employment Verification for Nurse Aides in Training. Before achieving full certification, nurse aides must submit this form as part of their training verification. It proves the completion of required training components and readiness for the state certification exam.
  • Form 5507-NAR: Request for Waiver of Nurse Aide Training and Competency Evaluation. This form is essential for individuals seeking exemption from the standard training and evaluation requirements, often due to equivalent training received in other healthcare roles or outside of Texas.
  • Form 5508-NAR: Nurse Aide Competency Evaluation Registration. To officially register for the competency evaluation (state exam), nurse aides must complete and submit this form, which details personal information and preferred testing sites.
  • Criminal History Report: Although not a form provided by the Texas Nurse Aide Registry, a current criminal history report may be required to accompany the 5506-NAR form for initial certification or recertification, especially if there's a disclosure of a conviction on the application. This report ensures transparency and compliance with health and safety codes.

The integration of these forms and documents into the certification and employment process for nurse aides in Texas underlines the multi-faceted nature of healthcare compliance and workforce management. For aspiring and current nurse aides, understanding these requirements is critical to maintaining professional credentials and ensuring the quality of care provided in healthcare settings.

Similar forms

The Texas 5506-NAR form shares similarities with employment verification forms used across various industries. Such forms are designed to verify an employee's work history, ensuring they meet specific job requirements or regulatory standards. Like the 5506-NAR, these documents typically require filling out by both the employee and their current or former employer. This process helps in confirming the employee's job title, the period of employment, and any relevant skills or certifications that align with job roles. The inherent similarity lies in the necessity to validate professional experience and qualifications formally.

Another document akin to the 5506-NAR is the Professional Reference Check Form. This type of form is utilized by employers to obtain feedback on a candidate’s professional demeanor, work ethic, and abilities from references listed by the candidate. Although it focuses more on qualitative assessments rather than verification of employment dates and positions, it shares the objective of ensuring a candidate's qualifications and reliability for a role, echoing the verification aspect of the 5506-NAR.

The I-9 Employment Eligibility Verification form is also similar in purpose to the 5506-NAR. The I-9 is a legally required document for all U.S. employees to verify their identity and eligibility to work in the United States. While the I-9 does not focus on professional qualifications, it parallels the 5506-NAR in its role to officially verify vital information for employment. Both forms serve as compliance tools to meet regulatory requirements, albeit in different contexts.

The Nursing Credential Verification Form is directly related to the healthcare field and shares a similar intent with the 5506-NAR. It's designed to verify a nurse's credentials, including education, licensure, and certifications. This form is crucial for maintaining standards within nursing professions and ensuring that individuals are properly qualified to provide care. This echoes the 5506-NAR’s role in affirming the qualifications and good standing of nurse aides within Texas.

Background Check Authorization Forms are also comparable. These forms give employers permission to conduct a background check on a candidate or employee, covering areas such as criminal records, employment history, and education. The link with the 5506-NAR form comes from the necessity to ensure the suitability of individuals for specific roles, especially where trust and security are paramount, as in healthcare and childcare occupations.

The Certification Renewal Form that professionals in various fields may encounter remarkably resembles the 5506-NAR. Specifically designed for individuals seeking to renew a professional certification, it often requires documenting continued education or practice hours, similar to the in-service education verification found in the 5506-NAR. This similarity underscores the ongoing commitment to professional development and adherence to industry standards.

The Continuing Education (CE) Credits Verification Form is utilized by professionals across various sectors to prove their participation in approved continuing education activities, necessary for maintaining licensure or certification. Like the 5506-NAR, this document serves a regulatory purpose, ensuring that professionals stay updated with the latest practices and knowledge in their field, emphasizing a commitment to high standards and quality service.

The License Verification Form, often used by regulatory boards or employers, requires verification of a professional’s licensure status directly from the issuing authority. It ensures the individual is licensed to practice in a specific field, akin to how the 5506-NAR verifies a nurse aide’s certification status and eligibility for recertification, highlighting the importance of regulatory compliance in professional practice.

The Volunteer Work Verification Form parallels the 5506-NAR form by documenting an individual’s volunteer contributions, often pertinent for roles or programs with a volunteering prerequisite. Despite the non-paid nature of volunteer work, this form emphasizes the validation of one's experience and the acquisition of relevant skills, mirroring the 5506-NAR’s employment verification process to affirm competency and suitability for specific duties.

Lastly, the Professional License Recertification Form shares a common purpose with the 5506-NAR. Aimed at professionals needing to renew their license to continue their practice, it typically mandates demonstrating ongoing professional development or competence, akin to the in-service education requirement of the 5506-NAR. This form underscores the perpetual cycle of learning and compliance within professional fields to safeguard public interest and ensure service quality.

Dos and Don'ts

When filling out the Texas 5506-NAR form, which is vital for the certification and recertification of nurse aides within the state, it is crucial to adhere to specific guidelines to ensure the process goes smoothly. Observing the do’s and don’ts can prevent unnecessary delays or rejections of your application. Here are some essential tips to guide you through:

Things You Should Do

  • Complete all information in Section 1 accurately: Ensure every detail you provide, including your name, contact information, and CNA certificate number, is correct and up to date to avoid processing delays.

  • Sign Section 1 to verify the correctness of information: Your signature is required to confirm that the information you've provided is true and accurate.

  • Get Section 2 completed by your employer: This part of the form needs to be filled out by your employer, certifying your employment and the performance of nursing-related services.

  • Ensure the employer’s signature in Section 2 is notarized: The form requires the employer's signature to be notarized to validate its authenticity. Make sure this step is not overlooked.

  • Email the completed form and necessary documents: Upon completion and notarization, email the form along with any required documents to the specified address to ensure it reaches the Texas Nurse Aide Registry promptly.

  • Verify your CNA certification status: Use the provided link to confirm your certification status, ensuring that your records are up to date and correctly reflected in the registry.

Things You Shouldn't Do

  • Avoid submitting incomplete forms: Incomplete submissions will be returned without action, causing delays in your certification or recertification process.

  • Do not forget to include required documents: Failing to attach necessary documents with your form can result in a delay or rejection of your application.

  • Resist the urge to submit unverified information: All information provided needs to be accurate and verifiable; submitting information that cannot be verified may lead to issues or potential penalties.

  • Do not overlook the in-service education requirements: Ensure you have completed the required 24 hours of in-service education in the past two years and are prepared to submit certificates if audited.

  • Avoid tampering with the form: Tampering with or attempting to falsify government records is a felony offense. Ensure all information provided is truthful and accurate.

  • Do not wait until the last minute to submit: Procrastination can lead to undue stress and potential errors. Give yourself ample time to fill out, verify, and submit the form well ahead of any deadlines.

Misconceptions

When discussing the Texas Nurse Aide Registry and the Form 5506-NAR, several misconceptions often arise. These misunderstandings can affect nurse aides seeking certification or recertification in Texas. This discussion aims to clarify these points for a better understanding of the process.

  • Misconception 1: Completing Section 1 is Sufficient for Submission

    A common misconception is that the nurse aide only needs to fill out and sign Section 1 of the Form 5506-NAR for the submission to be considered complete. However, both sections of the form must be properly filled out. Section 1 requires the nurse aide's personal and certification details, while Section 2 must be completed by the employer to verify employment in a nursing or nursing-related services role. Additionally, the employer's signature in Section 2 must be notarized before the form is sent to the Texas Nurse Aide Registry. Incomplete forms, or those missing the required notarization, will be returned without action.

  • Misconception 2: Every Nurse Aide Must Submit In-service Education Certificates with the Form

    Another misconstrued point is the belief that all nurse aides must submit certificates of their 24 hours of in-service education with the Form 5506-NAR. While the form does ask if the nurse aide has completed the required in-service education, detailed documentation is not immediately necessary with the form submission. Instead, these education requirements are subject to audit, and nurse aides should be prepared to present their in-service certificates if they are contacted by the Texas Health and Human Services Commission (HHSC).

  • Misconception 3: The Form Alone Can Recertify a Nurse Aide

    There is also a belief that submission of the Form 5506-NAR by itself is enough to ensure recertification. In truth, recertification as a Certified Nurse Aide (CNA) in Texas involves meeting several criteria beyond form submission, including the absence of disqualifying misconduct or convictions, and the completion of specific training in infection control and the proper use of personal protective equipment (PPE). The form is a part of the process to verify employment and fulfillment of these conditions, but it does not, on its own, guarantee recertification.

  • Misconception 4: The Nurse Aide Registry Does Not Allow for Information Correction

    Finally, some may believe that once information is submitted to the Texas Nurse Aide Registry, it cannot be corrected. This is not the case. Individuals have the right to request and be informed about the information HHSC obtains about them. If the information is found to be incorrect, they have the right to request that HHSC corrects this information. This ensures that nurse aide records accurately reflect their current certification status and credentials.

Understanding these aspects of the Form 5506-NAR process is crucial for nurse aides seeking to navigate the certification and recertification process effectively in Texas. It's important to read all instructions carefully and ensure that all parts of the form are correctly completed and submitted with the necessary documentation as required.

Key takeaways

When working with the Texas Nurse Aide Registry Form 5506-NAR, there are several important details to keep in mind to ensure the process goes smoothly. Here are five key takeaways:

  • Complete Section 1 thoroughly: It’s crucial that the Nurse Aide fills out all the information in Section 1 accurately and signs it to verify the correctness of the provided information. This includes basic personal information, certification details, and responses to specific questions regarding their employment and educational history.
  • Employer Verification is Mandatory: Section 2 must be completed by the employer, which includes verification that the individual has performed nursing or nursing-related services. Not only does this section require completion by an authorized individual, such as a program director or official keeper of records, but it also must be notarized to confirm the employer’s signature.
  • Email Submission: The completed form, along with any required documents, should be sent via email to the Texas Nurse Aide Registry at: nurseaideregistry@hhs.texas.gov. This digital submission method is convenient but also requires attention to detail to ensure that all attachments are included and correctly addressed.
  • In-service Education Verification: Be prepared to provide evidence of having completed 24 hours of in-service education in the past two years, including a course in infection control and proper use of personal protective equipment (PPE) once each year in the past 24 months. This requirement is auditable, which means it’s essential to keep records of these educational activities.
  • Check Your Certification and Rights: Individuals can verify their Certified Nurse Aide (CNA) certification status at any time by using the provided link. Additionally, it’s important to remember your rights regarding the information that Texas Health and Human Services Commission (HHSC) holds about you. You have the ability to request and review this information and seek corrections if needed.

Following these directions carefully can help ensure your Form 5506-NAR is processed efficiently and without delay, maintaining your certification and supporting your career as a Nurse Aide in Texas.

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