Texas 5506 Nar PDF Template

Texas 5506 Nar PDF Template

The Texas Nurse Aide Registry Form 5506-NAR is an essential document for nurse aides seeking employment verification in Texas. This form requires the nurse aide to complete their details and have their employer verify their employment history and compliance with certification requirements. Understanding how to accurately fill out this form is crucial for ensuring a smooth re-certification process.

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Overview

The Texas 5506 Nurse Aide Registry Form, commonly referred to as the 5506-NAR, serves as an essential tool for individuals seeking employment verification within the nursing profession. This form is particularly important for nurse aides to demonstrate their compliance with state regulations and to ensure their certifications are up to date. Filled out by the nurse aide and their employer, it consists of two key sections: the first focusing on the nurse aide's personal information and certification details, while the second requires verification from the employer regarding the aide’s employment status and performance. It is crucial for applicants to complete Section 1 honestly, as inaccuracies can lead to delays or denials of their certification renewal. Following the completion of both sections, the form must be emailed to the Texas Nurse Aide Registry, along with any required documents. Important reminders within the process highlight the necessity of notarizing the employer's signature and the potential consequences of falsifying information. Understanding these requirements can not only help nurse aides maintain their roles effectively but also contribute to the broader goal of upholding safety and care standards within healthcare settings across Texas.

Texas 5506 Nar Preview

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.

File Properties

Fact Name Fact Details
Form Purpose The Texas 5506-NAR is a Nurse Aide Registry form for employment verification.
Sections Breakdown It consists of two sections: one for the nurse aide and another for employer verification.
Email Submission Completed forms must be emailed to nurseaideregistry@hhs.texas.gov.
Verification Link CNA certification verification can be done at https://emr.dads.state.tx.us/DadsEMRWeb/.
In-service Education Nurse aides need 24 hours of in-service education in the past two years.
Legal Disclaimer Falsifying a nurse aide certificate is a third-degree felony, with severe penalties.
Governing Law This form is governed by Texas Health and Safety Code, §250.006.
Public Information Rights Under Government Code, Sections 552.021 and 552.023, individuals can request their personal information held by HHSC.

Instructions on Utilizing Texas 5506 Nar

Filling out the Texas 5506-NAR form is an important step in ensuring your Nurse Aide certification is verified correctly. Follow these instructions carefully to complete the form and submit it to the Texas Nurse Aide Registry. Make sure all necessary information is accurate and complete to avoid delays in processing.

  1. Begin in Section 1 by entering your full name: Last, First, and Middle.
  2. If applicable, provide your maiden name.
  3. Fill in your mailing address, including street or P.O. Box, City, State, and ZIP Code.
  4. Enter your Social Security Number.
  5. Provide your email address and daytime phone number with area code.
  6. Select your sex and enter your date of birth.
  7. Input your CNA certificate number.
  8. Answer the questions regarding your status on the Employee Misconduct Registry and criminal offenses.
  9. State whether you have completed 24 hours of in-service education in the past two years, and if you have completed an HHSC course on infection control in the last 24 months.
  10. Sign and date the form to verify that all information is correct.
  11. Have your employer complete Section 2. This must be done by the facility program director or official keeper of records.
  12. Your employer should notarize their signature in Section 2 and return the completed form to you.
  13. Email the completed form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.

It is essential to keep copies of your completed form and any correspondence for your records. Following these steps ensures that your Nurse Aide certification verification process goes smoothly and efficiently.

Important Facts about Texas 5506 Nar

What is the Texas 5506 Nar form?

The Texas 5506 Nar form, also known as the Nurse Aide Registry Form 5506-NAR, is a document used by individuals looking to verify employment as a nurse aide in Texas. It requires the nurse aide to fill out personal information in Section 1 and obtain employer verification in Section 2. Proper completion of the form is essential for maintaining certification status with the Texas Nurse Aide Registry.

Who needs to fill out this form?

The form must be filled out by anyone seeking to verify their Certified Nurse Aide (CNA) certification in Texas. This includes new applicants, those renewing their certification, or individuals wanting to confirm their employment history in nursing-related services.

What information do I need to provide in Section 1?

In Section 1, you will need to enter your full name, mailing address, social security number, email address, date of birth, and CNA certificate number. Additionally, you will answer questions regarding your employment history, criminal convictions, and completion of in-service education within the past two years.

How do I complete Section 2?

Section 2 must be completed by the employer. The employer or authorized personnel needs to certify your employment as a nurse aide, indicating the dates of service and confirming that there are no disqualifying misconduct issues. The employer’s signature must be notarized for the form to be valid.

Where do I send the completed form?

Once you have filled out both sections of the form, email it to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov. Make sure that all necessary information and documentation are included to avoid delays.

What happens if my form is incomplete?

Incomplete requests will be returned without action. To ensure your application is processed in a timely manner, double-check that all sections are fully completed and required documents are attached before submission.

Are there any education requirements for nurse aide recertification?

Yes, you need to have completed 24 hours of in-service education in the past two years. Additionally, you must complete a course in infection control and the proper use of personal protective equipment (PPE) at least once during the same period. These educational requirements are subject to random audits.

What are the consequences of tampering with the form?

Tampering with or falsifying this government record is treated very seriously. It is classified as a third-degree felony and could lead to severe penalties, including imprisonment for up to 10 years and fines reaching $10,000.

How can I verify my CNA certification status?

You can verify your certification status through the Texas Nurse Aide Registry's official link: https://emr.dads.state.tx.us/DadsEMRWeb/. This is a helpful resource to ensure your records are correct before submitting the 5506 Nar form.

Common mistakes

Filling out the Texas Nurse Aide Registry Form 5506-NAR can be straightforward, yet many individuals make common mistakes that can delay their application. One such mistake is failing to complete all information in Section 1. Every field is important, and leaving anything blank can lead to an incomplete request. This form requires personal details such as your name, mailing address, and Social Security Number. Ensure that each area is filled out accurately before submission.

Another frequent error is not obtaining the required employer verification in Section 2. This section must be filled out and notarized by your employer. If this step is skipped, the form will be returned without action, meaning you will have to start the process again. Make sure your employer understands that their signature is necessary for the form to be valid.

People often forget to sign and date their own section of the form. Just like your employer’s signature, your own signature verifies that all the provided information is correct. Without it, the form can’t be processed. Remember, your signature is just as critical as your employer’s.

Providing incorrect or outdated contact information is another mistake that can cause issues. Double-check your email address and phone number to ensure they are accurate. If the Texas Nurse Aide Registry needs to contact you, having the wrong information could delay receiving important updates about your application.

Some applicants may overlook the need for in-service education documentation. The form asks whether you have completed 24 hours of required in-service education within the past two years, and proof may be required. Failing to keep records can result in delays or complications in your certification process.

A significant mistake to avoid is failing to check your status with the Employee Misconduct Registry (EMR). If you are listed as unemployable, it will affect your application. Answer this question truthfully to prevent any legal consequences down the line.

Another common error involves submitting the form without the necessary documents. The Texas Nurse Aide Registry will return incomplete requests. It's essential to review the checklist of required documents and verify that everything is included with your submission.

Some applicants underestimate the importance of ensuring their employer has a qualifying position. If the facility does not meet specific criteria for employment as a nurse aide, the application may be denied. Ensure that your employer's credentials are valid to avoid issues with your recertification.

Lastly, tampering or attempting to falsify any information on the form can lead to serious legal consequences. This is a third-degree felony, which comes with harsh penalties. It’s crucial to provide honest and accurate information throughout your application process to avoid any potential legal troubles.

Documents used along the form

When submitting the Texas Nurse Aide Registry Form 5506-NAR, several additional documents may be required to facilitate the process. Having these forms ready can help ensure a smooth and timely review by the Texas Nurse Aide Registry.

  • Employee Misconduct Registry (EMR) Verification: This document confirms whether an individual has been listed as unemployable due to misconduct. It is crucial for ensuring compliance with nursing regulations.
  • Criminal Background Check Documentation: Providing proof of any criminal background check is necessary. This helps verify that the applicant has not been convicted of disqualifying offenses.
  • In-Service Education Certificates: Applicants must submit certificates for 24 hours of in-service education completed within the past two years. This documentation demonstrates ongoing professional development.
  • Employer Verification Letter: A letter from the employer certifying employment and the applicant's role as a nurse aide. This may include details about the duration of employment and any relevant comments regarding performance.

Be sure to gather these documents to support your application. This will help streamline the verification process and improve your chances of a successful outcome.

Similar forms

The Texas 5506 Nar form is essential for nurse aide certification and employment verification. Several other documents serve similar purposes, focusing on verification of skills, education, or employment status in the healthcare field. Here are six documents that are comparable:

  • Texas CNA Verification Form: This form is used to verify a Certified Nurse Aide's credentials directly with the Texas Nurse Aide Registry. Like the 5506 Nar form, it requires detailed information about the applicant and verifies employment history.
  • Employment Eligibility Verification (Form I-9): Employers use this form to verify an employee's identity and legal authorization to work in the U.S. Similar to the 5506 Nar form, it requires information about the employee's background and is crucial for employment processes.
  • Texas Criminal History Check Form: This document helps facilities assess whether potential employees have any criminal convictions that could disqualify them from working in healthcare. As with the 5506 Nar form, it aims to ensure patient safety and compliance with state regulations.
  • Application for Nurse Aide Certification: This application is necessary for individuals seeking to become certified nurse aides in Texas. It shares the goal of validating qualifications and background, similar to the verification processes within the 5506 Nar form.
  • Continuing Education Certificates: These certificates prove completion of required in-service education hours. They reinforce the educational requirements needed for nurse aides and highlight ongoing professional development, much like the education components in the 5506 Nar form.
  • Health Screening Documents: Facilities often require health screenings (such as TB tests or vaccinations) before hiring a nurse aide. These documents help ensure the safety of patients and align with the health-related verification processes included in the 5506 Nar form.

Dos and Don'ts

When filling out the Texas Nurse Aide Registry Form 5506-NAR, it is crucial to approach the process with care and precision. Below is a list of things to do and things not to do to ensure your application is completed correctly.

  • Do complete all information in Section 1 accurately, and sign to verify its correctness.
  • Do obtain employer verification in Section 2, ensuring it is completed properly.
  • Do email the form to the Texas Nurse Aide Registry at the designated email address.
  • Do provide a valid social security number and accurate contact information.
  • Don't forget to notarize the employer’s signature in Section 2.
  • Don't submit the form without checking for completeness; incomplete requests will be returned without action.
  • Don't attempt to falsify any information on the form, as it carries significant legal consequences.
  • Don't neglect to prepare in-service education certificates, as they may be required for audits.

Misconceptions

  • Misconception 1: The Texas 5506 NAR form is optional for nurse aide certification.
  • This form is mandatory for nurse aides looking to verify employment when applying for certification or recertification in Texas.

  • Misconception 2: Only the nurse aide must fill out the entire form.
  • While the nurse aide completes Section 1, Section 2 must be filled out by the employer. Both sections are essential for verification.

  • Misconception 3: The form does not require notarization.
  • Notarization of the employer's signature in Section 2 is a critical step in the process. Failure to provide a notarized signature can result in the form being returned without action.

  • Misconception 4: Providing incomplete information on the form is acceptable.
  • Submitting an incomplete form will lead the Texas Nurse Aide Registry to return the request without action. It is vital to ensure all required information is fully completed.

  • Misconception 5: The Texas Nurse Aide Registry does not verify criminal backgrounds.
  • The registry does check for any convictions listed under Texas Health and Safety Code, §250.006. Nurse aides must disclose any relevant criminal history when completing the form.

  • Misconception 6: In-service education hours are not audited.
  • In-service education requirements are subject to audit by the Texas Health and Human Services Commission (HHSC). Nurse aides must be prepared to show proof of continuing education if asked.

  • Misconception 7: You cannot check your certification status.
  • Nurse aides have the right to verify their certification status online through the provided link, ensuring they have accurate information on their credentials.

  • Misconception 8: Once submitted, the form cannot be corrected.
  • Nurse aides retain the right to request and correct any information that is deemed incorrect by the Texas Health and Human Services Commission.

Key takeaways

Here are some important points to keep in mind when filling out and using the Texas 5506 NAR form:

  • Complete Section 1: Make sure to fill out all the required information, including your name and contact details.
  • Sign and Verify: After completing Section 1, sign the form to confirm that all information you provided is accurate.
  • Employer Verification: Your employer must complete Section 2 and provide verification of your employment as a nurse aide.
  • Notarization Required: The signature from your employer needs to be notarized in Section 2.
  • Submission: Email the completed form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.
  • Education Requirements: Ensure that you have completed 24 hours of in-service education in the last two years.
  • Criminal History: Be aware of any convictions under Texas Health and Safety Code, as these may affect your certification.
  • Certificate Status: You can check your CNA certification status using the provided link: https://emr.dads.state.tx.us/DadsEMRWeb/.
  • Right to Information: You can request information about what HHSC has on file regarding your records and ask for corrections if needed.

Keeping these points in mind can help ensure your application process goes smoothly. Make sure to verify all information and submit everything as required to avoid delays.

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