The Texas Nurse Aide Registry Form 5506-NAR is a crucial document for individuals seeking to verify their employment as nurse aides in Texas. This form requires detailed information from both the nurse aide and their employer to ensure compliance with state regulations. If you need to fill out this form, click the button below to get started.
When filling out the Texas 5506 Nar form, there are important steps to follow. Here’s a list of what you should and shouldn’t do:
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?
If yes, give date of conviction.
Have you completed 24 hours of in-service education in the past two years?
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
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.:
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
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.
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.
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When completing the Texas Nurse Aide Registry Form 5506-NAR, several other forms and documents may be required or helpful to ensure a smooth application process. Below is a list of these documents, each serving a specific purpose in the certification and verification process.
Gathering these documents can help streamline the certification process and ensure compliance with state regulations. Always double-check the requirements to avoid any delays in your application.
Filling out the Texas Nurse Aide Registry Form 5506-NAR can be straightforward, yet many individuals make common mistakes that can delay the processing of their applications. One frequent error is failing to complete all required information in Section 1. Each field must be filled out accurately, including the applicant's full name, mailing address, and social security number. Omitting even a single piece of information may result in the form being returned without action.
Another common mistake involves the verification process. Section 2 of the form must be completed by the employer, which includes notarization of the employer's signature. Individuals sometimes overlook this requirement, resulting in an incomplete submission. It is essential for the employer to not only sign but also ensure that their signature is properly notarized to validate the employment verification.
Inaccurate responses to the questions regarding criminal history and employment misconduct can also lead to complications. Applicants must answer truthfully whether they are listed on the Employee Misconduct Registry or have been convicted of a disqualifying criminal offense. Providing false information, even unintentionally, could lead to serious legal consequences, including potential felony charges.
Furthermore, applicants often neglect to include documentation of their in-service education hours. The form requires evidence of 24 hours of in-service education completed within the past two years. If this documentation is not provided, the application may be subject to audit, and the Texas Nurse Aide Registry could request additional proof, which could delay the process.
Lastly, individuals may fail to submit the completed form and required documents to the correct email address. The Texas Nurse Aide Registry specifies that submissions should be sent to nurseaideregistry@hhs.texas.gov. Sending the form to an incorrect address can result in further delays and complications in processing the application. Ensuring that all steps are followed precisely is crucial for a smooth submission process.
This form is not limited to new applicants. It is also required for existing nurse aides who need to verify their employment and recertification status.
Section 1 must be completed by the nurse aide, but Section 2 requires the employer's input. Both sections are essential for the form to be valid.
Notarization is a critical step. The employer's signature in Section 2 must be notarized for the submission to be accepted.
Providing a mailing address is mandatory. It ensures that the Texas Nurse Aide Registry can communicate important information regarding the application.
Incomplete forms will be returned without action. It’s vital to ensure all sections are filled out completely before submission.
The completed form must be emailed to the Texas Nurse Aide Registry. Regular mail is not an accepted method of submission.
Nurse aides can verify their certification status using the provided link. This allows them to check if their application is being processed.
Submitting false information is a serious offense. It is classified as a third-degree felony, which can lead to significant penalties.
Only approved in-service education programs count towards recertification. It's important to verify the program's approval status before enrolling.
Nurse aides have the right to request and review their information held by the Texas Health and Human Services Commission. They can also ask for corrections if needed.
Completing the Texas 5506 Nar form requires careful attention to detail to ensure all necessary information is accurately provided. Once the form is filled out correctly, it will be submitted to the Texas Nurse Aide Registry for processing. Here are the steps to follow:
After submission, the Texas Nurse Aide Registry will review your application. If anything is incomplete or missing, they will return your request without action, so it’s crucial to ensure everything is filled out correctly before sending it off.