Content Overview
The Texas 5506 Nar form is a crucial document for individuals seeking to verify their employment as Certified Nurse Aides (CNAs) in Texas. It consists of two main sections that must be completed accurately to ensure successful processing. The first section is intended for the nurse aide, who must provide personal information, including their name, mailing address, and certification details. Additionally, the nurse aide must answer specific questions related to their employment history and compliance with in-service education requirements. This section requires the nurse aide's signature to confirm the accuracy of the information provided. The second section is designated for the employer, who must validate the nurse aide's employment and certify that no disqualifying misconduct has occurred. Notarization of the employer's signature is also a requirement, adding an extra layer of verification. It is important to note that incomplete forms or those lacking required documentation will be returned without action. For those looking to verify their CNA certification or obtain additional resources, links to the Texas Nurse Aide Registry and approved education programs are provided within the form. Understanding the significance of this form and the steps involved in its completion can greatly assist nurse aides in maintaining their certification and employment status.
Document Preview
Form 5506-NAR
September 2021-E
Texas Nurse Aide Registry
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: [email protected]. 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: State: ZIP Code: Daytime Phone No. with Area Code:
Social Security No.:
Sex:
Male Female
Date of Birth: CNA Certificate No.:
Email Address:
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
in the past 24 months?
Yes No
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
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.
Place Notary Seal or Stamp Here
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
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.
Form Specifications
| Fact Name | Description |
|---|---|
| Form Title | Texas Nurse Aide Registry Form 5506-NAR |
| Version Date | September 2021-E |
| Submission Method | The completed form must be emailed to [email protected]. |
| Employer Verification | Section 2 must be completed by the employer and notarized. |
| Criminal History Disclosure | Applicants must disclose any convictions listed in Texas Health and Safety Code, §250.006. |
| In-Service Education Requirement | Applicants must complete 24 hours of in-service education within the past two years. |
| Tampering Penalty | Falsifying records is a third-degree felony, punishable by up to 10 years in prison and a $10,000 fine. |
| Right to Information | Individuals can request to review and correct information held by the Texas Health and Human Services Commission (Government Code, Sections 552.021, 552.023, 559.004). |
Texas 5506 Nar: Usage Guidelines
Filling out the Texas 5506-NAR form is an essential step for nurse aides seeking recertification. Once completed, this form will be submitted to the Texas Nurse Aide Registry for processing. It's important to follow each step carefully to ensure that your application is complete and accurate.
- Begin by filling out Section 1 of the form. Provide your full name, including your maiden name if applicable.
- Enter your mailing address, including street or P.O. Box, city, state, and ZIP code.
- Fill in your social security number, email address, and daytime phone number with area code.
- Select your sex and enter your date of birth.
- Provide your Certified Nurse Aide (CNA) certificate number.
- Answer the questions regarding your status on the Employee Misconduct Registry and any criminal convictions.
- Indicate whether you have completed 24 hours of in-service education in the past two years and if you have completed an HHSC course in infection control and PPE usage in the past 24 months.
- Sign and date the form to verify that all information is correct.
- Move to Section 2 to obtain employer verification. Your employer must complete this section.
- Your employer should provide their name or company name, daytime area code and phone number, and mailing address.
- They must certify your employment details, including the dates of employment and any disqualifying misconduct.
- Have your employer sign and date the form.
- Ensure that the employer's signature is notarized at the bottom of Section 2.
- Double-check that all sections are completed and signed.
- Email the completed form and any required documents to the Texas Nurse Aide Registry at [email protected].
After submitting the form, keep an eye on your email for any communication from the Texas Nurse Aide Registry. They may reach out for additional information or to confirm your recertification status. Make sure to retain copies of your submitted documents for your records.
Your Questions, Answered
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 required for verifying employment and recertification of Certified Nurse Aides (CNAs) in Texas. It consists of two sections: one for the nurse aide to complete and sign, and another for the employer to verify employment details. This form is essential for maintaining compliance with state regulations regarding nurse aide certification.
Who needs to fill out the Texas 5506 Nar form?
Any individual seeking to verify their employment as a nurse aide and maintain their certification in Texas must fill out this form. This includes CNAs who are recertifying their credentials and need to provide proof of their work history and completion of required in-service education hours.
What information is required in Section 1 of the form?
In Section 1, the nurse aide must provide personal details such as their name, mailing address, social security number, email address, and date of birth. They also need to indicate their CNA certificate number and answer questions regarding their employment history and compliance with in-service education requirements. Finally, the nurse aide must sign the form to verify that the information provided is accurate.
What does Section 2 entail?
Section 2 is to be completed by the employer. This section requires the employer to certify that the nurse aide was employed and performed nursing-related services during a specified time frame. The employer must also confirm that they are not aware of any disqualifying misconduct. After filling out this section, the employer's signature must be notarized to validate the information provided.
How do I submit the completed Texas 5506 Nar form?
Once both sections of the form are completed and signed, the nurse aide must email the form to the Texas Nurse Aide Registry at [email protected]. It is crucial to ensure that all information is accurate and that the employer's signature is notarized, as incomplete forms will be returned without action.
What happens if I do not meet the requirements for recertification?
If a nurse aide does not meet the recertification requirements, such as being listed on the Employee Misconduct Registry or failing to complete the required in-service education hours, they may be ineligible for recertification. It is essential to review all requirements carefully and ensure compliance to avoid any issues with certification status.
Where can I find additional resources related to the Texas 5506 Nar form?
Additional resources can be found on the Texas Health and Human Services website. This includes links to verify CNA certification status and access to approved in-service education programs. For any questions or further assistance, you can contact the Nurse Aide Registry at 512-438-2050.
Common mistakes
-
Incomplete Information: Failing to fill out all sections of Section 1 can lead to delays. Ensure every required field is completed.
-
Missing Signature: Not signing Section 1 is a common oversight. Your signature is necessary to verify the accuracy of the information provided.
-
Employer Verification Issues: Section 2 must be completed by the employer. If this section is left blank or incorrectly filled out, it will delay processing.
-
Notarization Errors: The employer's signature in Section 2 must be notarized. Failing to do this can result in the form being returned.
-
Omitting Required Documents: If you do not include necessary documents with your submission, the Texas Nurse Aide Registry will return your request without action.
-
Incorrect Contact Information: Providing an incorrect email address or phone number can hinder communication regarding your application.
-
Not Checking Criminal History: If you have a conviction listed in Texas Health and Safety Code, it is essential to disclose this information accurately.
-
Ignoring In-Service Education Requirements: Ensure you have completed the required 24 hours of in-service education. Failing to do so may affect your recertification.
Documents used along the form
The Texas Nurse Aide Registry Form 5506-NAR is an essential document for individuals seeking to verify their status as Certified Nurse Aides (CNAs). However, several other forms and documents often accompany this application, ensuring a comprehensive review process. Below is a list of these additional documents, each playing a critical role in the verification and recertification process.
- Employment Verification Letter: This letter, typically provided by the employer, confirms the nurse aide's employment status, including job title and duration of employment. It serves as an official record of the nurse aide's work history.
- In-Service Education Certificates: These certificates document the completion of required continuing education courses. Nurse aides must show proof of 24 hours of in-service education every two years to maintain their certification.
- Criminal Background Check Results: This document provides information on any criminal offenses that may affect the nurse aide's eligibility. It is crucial for ensuring the safety and integrity of care provided to patients.
- Employee Misconduct Registry (EMR) Verification: A confirmation that the nurse aide is not listed as unemployable on the EMR. This is vital for the protection of vulnerable populations in healthcare settings.
- Notarized Affidavit: This document, signed by the employer, attests to the truthfulness of the information provided in the employment verification section. It adds a layer of legal credibility to the application.
- Personal Protective Equipment (PPE) Training Certificate: Proof that the nurse aide has completed training in infection control and proper use of PPE. This training is essential for maintaining safety standards in healthcare environments.
- Application for Nurse Aide Certification: This form is often required for individuals applying for initial certification. It includes personal information, educational background, and details about any prior certifications.
Each of these documents plays a vital role in ensuring that nurse aides meet the necessary requirements for certification and recertification. By providing a comprehensive set of information, applicants can facilitate a smoother review process, ultimately supporting their professional journey in the healthcare field.
Similar forms
The Texas 5506 Nurse Aide Registry Form is essential for verifying employment and certification for nurse aides. Similar forms serve comparable purposes in various professional contexts. Here are four documents that share similarities with the Texas 5506-NAR form:
- Employment Verification Form: This document is used by employers to confirm an employee's work history and job performance. Like the Texas 5506-NAR, it requires signatures from both the employee and the employer, ensuring that the information provided is accurate and verifiable.
- Professional License Verification Form: This form is utilized to confirm that a professional holds a valid license in their field. Similar to the Texas 5506-NAR, it often requires the licensee's information and may need to be submitted to a regulatory body for validation.
- Background Check Authorization Form: This document allows an employer to conduct a background check on a potential employee. Much like the Texas 5506-NAR, it involves the applicant's consent and requires detailed personal information to process the request.
- Certification Renewal Application: Used by professionals to renew their certifications, this form often includes sections for employment verification and proof of continued education. It mirrors the Texas 5506-NAR in its need for thorough documentation and employer input to ensure compliance with regulatory standards.
Dos and Don'ts
When filling out the Texas 5506-NAR form, it is essential to follow certain guidelines to ensure your application is processed smoothly. Below is a list of things you should and shouldn't do:
- Do complete all information in Section 1 accurately and sign the form to verify its correctness.
- Do ensure that your employer completes Section 2 and provides a notarized signature.
- Do verify your Certified Nurse Aide (CNA) certification status using the provided link.
- Do check that all required documents are attached before submitting the form.
- Don't leave any sections of the form blank; incomplete forms will be returned without action.
- Don't attempt to falsify any information on the form, as this is a serious offense.
By adhering to these guidelines, you can help ensure that your application for the Texas Nurse Aide Registry is handled efficiently and correctly.
Misconceptions
- Misconception 1: The Texas 5506 Nar form can be submitted without employer verification.
- Misconception 2: All sections of the form can be filled out by the applicant alone.
- Misconception 3: The form can be submitted in any format.
- Misconception 4: In-service education hours are optional for recertification.
This is incorrect. Section 2 of the form must be completed by the employer. Their verification is essential for the processing of the application.
This is not true. While the applicant completes Section 1, Section 2 requires input from the employer. Both sections are crucial for a valid submission.
This is misleading. The completed form must be emailed to the Texas Nurse Aide Registry. Other submission methods may not be accepted.
This is false. Completing 24 hours of in-service education in the past two years is a requirement for nurse aide recertification. Failure to meet this requirement can lead to complications in the recertification process.
Key takeaways
Filling out the Texas 5506 Nar form is an important step for nurse aides. Here are some key takeaways to keep in mind:
- Complete all information in Section 1 before signing the form.
- Ensure your employer fills out Section 2 and notarizes their signature.
- Email the completed form to the Texas Nurse Aide Registry at [email protected].
- Verify your CNA certification status online at https://emr.dads.state.tx.us/DadsEMRWeb/.
- Be aware that incomplete requests will be returned without action.
- Keep records of your in-service education, as it may be audited.
- Check if you are listed on the Employee Misconduct Registry (EMR) before applying.
- Falsifying information on the form can lead to serious legal consequences.
- Contact the Nurse Aide Registry at 512-438-2050 if you need assistance or have questions.
- Remember to include your social security number and other personal details accurately.
By following these steps, you can ensure a smoother process in maintaining your certification as a nurse aide in Texas.