Fill Your Texas 5506 Nar Form Launch Texas 5506 Nar Editor Now

Fill Your Texas 5506 Nar Form

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.

Launch Texas 5506 Nar Editor Now

Dos and Don'ts

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:

  • Do complete all information in Section 1 and sign the form to confirm accuracy.
  • Do ensure your employer completes Section 2 and notarizes their signature.
  • Do email the completed form and required documents to the Texas Nurse Aide Registry.
  • Do verify your CNA certification status using the provided link.
  • Don't leave any sections blank; incomplete forms will be returned without action.
  • Don't forget to provide your Social Security number and contact information.
  • Don't attempt to falsify any information on the form; this is a serious offense.
  • Don't ignore the requirement to submit in-service education certificates if requested.

Sample - 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.

More PDF Templates

Documents used along the form

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.

  • Employee Misconduct Registry (EMR) Verification: This document confirms whether an individual is listed on the EMR as unemployable due to misconduct. It is essential for maintaining the integrity of healthcare services.
  • Criminal Background Check: A report that provides details on any criminal convictions. This is important for compliance with Texas Health and Safety Code requirements regarding nurse aide certification.
  • In-Service Education Certificates: These certificates demonstrate that the nurse aide has completed the required 24 hours of in-service education within the past two years, as mandated by the Texas Nurse Aide Registry.
  • Notarized Employment Verification Letter: A letter from the employer that verifies the nurse aide's employment, including dates and job responsibilities. This document must be notarized to be valid.
  • Proof of Infection Control Training: Documentation showing that the nurse aide has completed training in infection control and the proper use of personal protective equipment (PPE) within the last 24 months.
  • Identification Documents: A copy of a government-issued ID, such as a driver's license or passport, may be required to verify the identity of the nurse aide.
  • Application for Certification Renewal: If the nurse aide is renewing their certification, this application must be submitted along with the required documentation to maintain active status.

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.

Common mistakes

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.

Misconceptions

  • Misconception 1: The Texas 5506 Nar form is only for new nurse aides.
  • 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.

  • Misconception 2: Only the nurse aide needs to fill out the form.
  • 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.

  • Misconception 3: The form can be submitted without notarization.
  • Notarization is a critical step. The employer's signature in Section 2 must be notarized for the submission to be accepted.

  • Misconception 4: It’s not necessary to provide a mailing address.
  • Providing a mailing address is mandatory. It ensures that the Texas Nurse Aide Registry can communicate important information regarding the application.

  • Misconception 5: The Texas Nurse Aide Registry will process incomplete forms.
  • Incomplete forms will be returned without action. It’s vital to ensure all sections are filled out completely before submission.

  • Misconception 6: The form can be submitted via regular mail.
  • The completed form must be emailed to the Texas Nurse Aide Registry. Regular mail is not an accepted method of submission.

  • Misconception 7: Once submitted, there’s no way to track the application status.
  • Nurse aides can verify their certification status using the provided link. This allows them to check if their application is being processed.

  • Misconception 8: There are no consequences for submitting false information.
  • Submitting false information is a serious offense. It is classified as a third-degree felony, which can lead to significant penalties.

  • Misconception 9: All in-service education programs are acceptable.
  • Only approved in-service education programs count towards recertification. It's important to verify the program's approval status before enrolling.

  • Misconception 10: Nurse aides do not have the right to access their information.
  • 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.

Key takeaways

  • Complete Section 1: As a nurse aide, fill out all information in Section 1 accurately. Don’t forget to sign the form to confirm that your details are correct.
  • Employer Verification Required: Section 2 must be completed by your employer. This includes notarizing their signature, so ensure they understand this step.
  • Email Submission: After completing the form, email it to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.
  • Verify Your CNA Status: You can check your Certified Nurse Aide (CNA) certification status online at the provided link.
  • In-Service Education: Ensure you have completed 24 hours of in-service education in the past two years, as this is a requirement for recertification.
  • Audit Preparedness: Be ready to submit your in-service certificates if the Texas Health and Human Services Commission (HHSC) contacts you for an audit.
  • Legal Consequences: Be aware that tampering with this form or providing false information can lead to serious legal repercussions, including imprisonment and fines.

File Characteristics

Fact Name Details
Purpose of Form The Texas Nurse Aide Registry Form 5506-NAR is used for employment verification of Nurse Aides, ensuring compliance with state regulations.
Completion Requirements Section 1 must be completed by the Nurse Aide, while Section 2 requires verification from the employer, including notarization.
Submission Process The completed form must be emailed to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.
Governing Laws This form is governed by Texas Health and Safety Code, specifically §250.006, which outlines the requirements for Nurse Aide certification and recertification.

How to Use Texas 5506 Nar

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:

  1. Begin with Section 1. Fill in your name, including last, first, and middle names. If applicable, include your maiden name.
  2. Provide your mailing address, including street or P.O. Box, city, state, and ZIP code.
  3. Enter your Social Security number, email address, and daytime phone number with area code.
  4. Select your sex and enter your date of birth.
  5. Input your CNA certificate number.
  6. Answer the questions regarding the Employee Misconduct Registry and any criminal convictions. If applicable, provide the date of conviction.
  7. Indicate whether you have completed 24 hours of in-service education in the past two years and whether you have completed an HHSC course in infection control and PPE usage within the last 24 months.
  8. Sign and date Section 1 to verify that all information is correct.
  9. Move to Section 2. This section must be filled out by your employer. Provide the employer's name or company name, daytime phone number, and mailing address.
  10. Your employer must certify your employment as a nurse aide and the dates of service. They should also confirm they are not aware of any disqualifying misconduct.
  11. Your employer needs to sign and date Section 2, and their signature must be notarized.
  12. Before submitting, double-check that you have signed and completed all information in Section 1 and that your employer has notarized their signature in Section 2.
  13. Email the completed form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.

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.