Download Texas 5506 Nar Template Fill Out Your Document

Download Texas 5506 Nar Template

The Texas Nurse Aide Registry Form 5506-NAR is a crucial document for Nurse Aides in Texas aiming to verify or recertify their certification. It involves a two-section form; the first section is to be completed by the Nurse Aide, and the second part requires verification from their employer, which must be notarized before sending it to the Texas Nurse Aide Registry. If you are a nurse aide looking to recertify, ensure you fill out the form accurately by clicking the button below.

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The Texas 5506-NAR form is an essential document for Certified Nurse Aides (CNA) within the state, facilitating the verification process for their certification status. This form, updated in September 2021, serves a dual purpose by requiring completion from both the nurse aide and their employer. Nurse aides are tasked with providing accurate personal and professional information in Section 1, including any potential disqualifications such as listings on the Employee Misconduct Registry or criminal convictions under Texas Health and Safety Code, §250.006. This section also probes the completion of necessary in-service education, highlighting the state's commitment to maintaining high standards for those involved in patient care. It’s imperative for CNAs to achieve and document completion of 24 hours of in-service education over two years and specific courses in infection control. Meanwhile, Section 2 necessitates employer verification of the nurse aide’s claim, further buttressed by the requirement of a notarized signature, underscoring the legal weight of the form. The instructions detail the proper submission process, including the official email address for the Texas Nurse Aide Registry, emphasizing the importance of a thorough, accurate, and documented verification process for the recertification of nurse aides. This procedure not only adheres to regulatory compliance but also ensures the quality and reliability of care provided to patients, encapsulating the form's significance in safeguarding public health and welfare.

Document Example

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.

Form Information

Fact Detail
Form Number and Name Texas Nurse Aide Registry Form 5506-NAR, September 2021-E Employment Verification
Completion and Signature Nurse Aides must complete Section 1 and provide a signature to confirm the accuracy of the information.
Employer Verification Requirement Section 2 requires completion by the employer, who must also notarize their signature.
Submission Email The completed form must be emailed to nurseaideregistry@hhs.texas.gov.
Certification Verification Link Certified Nurse Aide (CNA) certification can be verified at https://emr.dads.state.tx.us/DadsEMRWeb/.
Governing Law and Penalties Tampering with or attempting to falsify the Form 5506-NAR is a third-degree felony, punishable by up to 10 years in prison and a $10,000 fine.

How to Use Texas 5506 Nar

Completing the Texas 5506-NAR Form is a crucial step in maintaining your status as a Certified Nurse Aide (CNA). This form serves as a verification of employment and is necessary for the recertification of CNAs in Texas. To ensure your recertification process is smooth and successful, it's important to fill out the form correctly and submit it with all the required documentation. Below, you'll find step-by-step instructions to guide you through filling out the form accurately. Remember, an incomplete form or a form without the necessary documents will be returned without action, so pay close attention to the details.

  1. Complete Section 1:
    • Enter your full name (Last, First, Middle) and maiden name if applicable.
    • Provide your mailing address (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.
    • Input your CNA Certificate Number.
    • Answer questions regarding your listing on the Employee Misconduct Registry (EMR), any convictions of criminal offenses listed in the Texas Health and Safety Code, §250.006, completion of required in-service education, and completion of an HHSC course in infection control and proper use of personal protective equipment (PPE).
    • Review all the information you've entered for accuracy, then sign and date the form to verify the correctness of the information provided.
  2. Obtain Employer Verification in Section 2:
    • The form must be completed by your employer, the facility program director, the official keeper of records, or your actual employer.
    • The employer's signature must be notarized at the bottom of this section. Make sure they also provide their name or company name, daytime phone number with area code, mailing address, city, state, and ZIP code. They should certify your employment as a nurse aide, including the dates of employment, and any comments if necessary.
    • Once completed and notarized, this section should be returned to you for submission.
  3. Email the completed form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.
  4. After sending your form, you can verify the status of your CNA certification and any further steps through the provided link: https://emr.dads.state.tx.us/DadsEMRWeb/.

Once you have completed all steps, your form and documents will be reviewed by the Texas Nurse Aide Registry. Remember, it's important to keep a copy of all documents sent for your records. Should there be any issues or if additional information is needed, the Texas Nurse Aide Registry will contact you. Stay proactive by verifying your certificate status through the link provided after submission and be prepared to submit additional information if contacted by the Texas Health and Human Services Commission (HHSC).

Listed Questions and Answers

What is the Texas 5506-NAR form, and who needs to complete it?

The Texas 5506-NAR form is designed for the employment verification of Certified Nurse Aides (CNAs) in the state of Texas. This document is essential for CNAs seeking to renew their certification and ensure their eligibility to work. The form is divided into two main sections. The first section is to be filled out by the nurse aide themselves, confirming personal details and compliance with specific requirements. The second part requires completion and notarization by the employer, attesting to the employment status and performance of the nurse aide. This form is necessary for all CNAs in Texas undergoing the recertification process.

How does one fill out Section 1 of the Texas 5506-NAR form?

Section 1 of the form requires the nurse aide to provide personal information, including their name, mailing address, Social Security Number, email address, and certification number. Additionally, the aide must answer questions regarding their listing on the Employee Misconduct Registry, any criminal convictions relevant to their work, and their completion of required in-service education and training in infection control and proper use of personal protective equipment (PPE) in the last two years. After completing this section, the nurse aide must sign the form, attesting to the correctness of the provided information.

What are the steps for an employer to complete Section 2?

In Section 2, the employer or the facility program director must confirm the employment details of the nurse aide, including the duration of employment and the type of services performed. The employer also needs to clarify that they are not aware of any disqualifying misconduct by the nurse aide. This section requires notarization; therefore, the employer's signature must be witnessed and stamped by a notary public before the form can be returned to the nurse aide for submission.

When and how should the Texas 5506-NAR form be submitted?

Once both sections of the form are duly filled and signed, with Section 2 notarized, the completed document should be emailed to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov. Ensure that all the required fields are filled out correctly and that you attach any requested documents to prevent the form from being returned without action. It's advisable to complete and submit this form well in advance of the re-certification due date to allow sufficient time for processing.

How can one verify their CNA certification status in Texas?

Certified Nurse Aides (CNAs) can verify their certification status by accessing the Texas Department of Aging and Disability Services (DADS) Emergency Management System (EMS) online platform via the link provided in the form instructions (https://emr.dads.state.tx.us/DadsEMRWeb/). This platform allows CNAs to check the status of their certification and any other details related to their registry information. Verification through this portal is an effective way to ensure that one's certification status is current and recognized by state authorities.

What are the consequences of falsifying the Texas 5506-NAR form?

Falsifying a government record, including the Texas 5506-NAR form, is a serious offense classified as a third-degree felony. Individuals found guilty of tampering with or attempting to falsify this form face severe penalties, which can include up to 10 years in prison and a fine of up to $10,000. It is crucial to provide accurate and truthful information when completing and submitting this form to avoid legal repercussions.

Common mistakes

Completing the Texas 5506-NAR form is crucial for Nurse Aides seeking employment or recertification within the state. However, individuals commonly make mistakes that can delay or impact their certification status. Understanding these errors can streamline the process and ensure applications are processed efficiently.

  1. Not fully completing Section 1: It's essential to provide all requested information in Section 1, including personal details and responses to all questions about certification and any criminal history.
  2. Failure to sign Section 1: The applicant's signature verifies that the information provided is accurate and complete. An unsigned form is considered incomplete.
  3. Omitting the email address: Providing a current email address is necessary for communication purposes. The Texas Nurse Aide Registry uses it to send important updates or requests for additional information.
  4. Inaccurate or incomplete employer information in Section 2: It's crucial that the employer's details are filled out correctly. Mistakes or omissions can lead to verification delays.
  5. Employer’s signature not notarized: The employer’s signature must be notarized to validate the employment information provided by the applicant. Without notarization, the form will be returned without action.
  6. Not including required in-service education documentation: If audited, applicants must provide certificates of completed in-service education. Failing to include these when requested can result in certification issues.
  7. Forgetting to check the Employee Misconduct Registry (EMR): Applicants must ensure they are not listed as unemployable on the EMR. Neglecting to verify this and accurately report it on the form can lead to serious repercussions.
  8. Assuming completion of in-service education without verification: Applicants need to confirm that their in-service education meets Texas Health and Human Services Commission standards. Assuming compliance without verification can lead to mistakes on the form.
  9. Sending the form to the wrong email address: The correct email for submitting the form is nurseaideregistry@hhs.texas.gov. Using an incorrect address can lead to delays in processing.

Avoiding these common errors can help ensure the timely and successful processing of the Texas 5506-NAR form. Applicants should always double-check each section of the form, provide accurate and complete information, and verify that all requirements have been met before submission.

Documents used along the form

When working with the Texas Nurse Aide Registry Form 5506-NAR, understanding other essential forms and documents that are often used in conjunction can be crucial for a comprehensive approach. These documents serve various purposes, from verifying employment and criminal history to ensuring compliance with state health regulations. They form an essential part of the certification and recertification process for Nurse Aides in Texas.

  • Form 5505-NAR: Request for Entry on the Texas Nurse Aide (NA) Registry through Reciprocity. This form is used by CNAs who are certified in another state and wish to be listed on the Texas Nurse Aide Registry.
  • Form 5507-NAR: Employment Verification. Similar to the 5506-NAR form, this document verifies employment for nurse aides seeking to show proof of work history in the state of Texas.
  • Criminal History Check: An essential step in the certification process, this background check ensures that the applicant does not have a disqualifying criminal offense per Texas Health and Safety Code, §250.006.
  • In-Service Education Documentation: Proof of completing the required 24 hours of in-service education every two years, crucial for recertification and maintaining active status on the registry.
  • Infection Control and PPE Training Certification: Documentation verifying the completion of an HHSC-approved course in infection control and proper use of personal protective equipment (PPE), as mandated for recertification.
  • Form 5528-NAR: Nurse Aide Registry Update. This form allows current CNAs to update their personal information, such as address or name changes, ensuring the registry's records are accurate and up to date.
  • Employee Misconduct Registry (EMR) Check: A verification process to ensure the applicant is not listed on the EMR as unemployable due to misconduct related to patient care or services.

Each document plays a specific role in ensuring that Nurse Aides meet the stringent requirements set by Texas laws and regulations. By familiarizing themselves with these forms and documents, Nurse Aides and their employers can navigate the certification and recertification process more smoothly, ensuring compliance and promoting the highest standards of care in the healthcare environment.

Similar forms

One similar document to the Texas 5506-NAR form is the Employment Eligibility Verification Form I-9, required by the U.S. Citizenship and Immigration Services. Both forms are crucial for verifying an individual's eligibility – the 5506-NAR for verifying nurse aide certification status in Texas, and the Form I-9 for establishing that employees are legally allowed to work in the United States. Each form necessitates personal information, employment history, and an official verification process, underscoring their roles in compliance and regulatory operations.

The California Department of Public Health (CDPH) 283C form, used for certified nurse assistant (CNA) initial application and certification in California, has functionalities similar to the Texas 5506-NAR form. Both are state-specific forms aiming to maintain standards within the nursing profession by verifying credentials and employment. While the 283C form is more focused on initial certification, the Texas 5506-NAR emphasizes employment verification and is necessary for recertification, drawing parallels in their goals to uphold quality care through accredited personnel.

A similarity can also be found with the Employment Verification Letter, often used by companies to confirm an employee's current or past job status and salary information. Like Section 2 of the 5506-NAR form, an employment verification letter requires an official company signature, sometimes notarization, to validate the employee's work experience. Though broader in usage, both documents serve to officially acknowledge professional experience, crucial for various bureaucratic and personal needs such as loan applications or future employment verification.

The Nurse Aide Verification (NAV) form, used in several states to verify a nurse aide's status on the state registry, parallels the Texas 5506-NAR form in purpose. Although each state might have its specific procedural nuances, the NAV form functions similarly by confirming a nurse aide's certification, ensuring they are in good standing for employment in healthcare settings. Like the 5506-NAR, it plays a fundamental role in safeguarding patient care quality through credential verification.

The Professional Reference Letter shares objectives with the employment verification section of the Texas 5506-NAR. While a professional reference letter is more narrative, outlining an individual's qualities, skills, and professional demeanor, the 5506-NAR's employment verification provides official and concise confirmation of employment status. Both are used to support professional credibility, yet through distinct formats: one through subjective endorsement and the other through objective validation.

The Certified Background Check, commonly conducted for job applicants, mirrors the Texas 5506-NAR's intent to validate the professional conduct and status of nurse aides in Texas. While the certified background check encompasses a broader spectrum including criminal records and educational verification, the 5506-NAR is focused specifically on nursing credentials and employment history. Each serves to ensure the integrity of professionals within sensitive work environments.

Last but not least, the Continuing Education Units (CEU) Verification Form, necessary for various professionals to prove their participation in required continuing education for licensure or certification renewal, shares similarities with the Texas 5506-NAR form's in-service education verification. Both forms are pivotal in demonstrating ongoing professional development and adherence to updated best practices within one's field, though the CEU Verification Form specifically focuses on educational attainment rather than the broader employment and certification scope of the 5506-NAR.

Dos and Don'ts

Filling out the Texas 5506-NAR form is a crucial step for Nurse Aides seeking recertification or verification in Texas. Paying careful attention to the form's requirements ensures a smooth process. Here are several do's and don'ts to guide you through completing this important document:

  • Do ensure that all information in Section 1 is complete and accurate before signing to verify. Incorrect or incomplete entries can delay your certification process.
  • Do obtain employer verification in Section 2 as the form is incomplete without this endorsement and cannot be processed.
  • Do remember to have your employer notarize their signature in Section 2. This step is mandatory for the validation of the form.
  • Do email the completed form along with any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov for processing.
  • Do verify your CNA certification status using the provided link to ensure all your records are up to date.
  • Don't leave any sections incomplete. The Texas Nurse Aide Registry will return any forms that are not fully completed.
  • Don't forget to check if you're listed on the Employee Misconduct Registry or have any disqualifying criminal convictions, as these are crucial eligibility criteria.

Remember, accurate and attentive completion of the Texas 5506-NAR form is a step toward maintaining your certification and professional standing as a Nurse Aide in Texas. Keep these tips in mind to ensure your submission is complete and processed efficiently.

Misconceptions

Understanding the Texas Nurse Aide Registry Form 5506-NAR is crucial for nurse aides seeking recertification in Texas. However, there are several common misconceptions about the form and its requirements. Clarifying these misconceptions is key to ensuring that nurse aides complete the form accurately and meet all the necessary criteria for recertification.

  • Misconception 1: Completion of Section 1 by the nurse aide is optional.

    Truth: Every nurse aide is required to complete Section 1 in full and provide a signature to verify the accuracy of the information provided. This step is mandatory and ensures the nurse aide's accountability for the information submitted.

  • Misconception 2: Employer verification is not necessary for all applicants.

    Truth: Employers must complete and notarize Section 2 for all nurse aides applying for recertification. This process verifies the aide's employment and absence of disqualifying misconduct.

  • Misconception 3: The form can be submitted without being notarized.

    Truth: The employer's signature in Section 2 must be notarized to fulfill the form’s requirements. Notarization adds a layer of verification and legal authenticity to the employer’s declaration.

  • Misconception 4: Nurse Aides can submit the form via mail or fax.

    Truth: The completed form, along with the required documents, must be emailed to the Texas Nurse Aide Registry at the specified email address. This ensures a faster processing and reduces the risk of lost documents.

  • Misconception 5: In-service education can be deferred.

    Truth: Nurse aides must complete 24 hours of in-service education in the preceding two years before recertification. Moreover, they need an HHSC-approved course in infection control and proper use of personal protective equipment (PPE) annually. These requirements are auditable and essential for maintaining high standards of care.

  • Misconception 6: Any criminal conviction disqualifies an applicant.

    Truth: Only convictions of criminal offenses listed in the Texas Health and Safety Code, §250.006, lead to disqualification. Nurse aides must disclose such convictions but should verify whether their specific circumstances disqualify them.

  • Misconception 7: The Texas Nurse Aide Registry does not provide resources for in-service education.

    Truth: The registry offers links to approved in-service education programs. Nurse aides are encouraged to visit the provided websites to find programs that satisfy the recertification requirements.

  • Misconception 8: Incorrect information on the form has no consequences.

    Truth: Providing false information or attempting to falsify government records, including the nurse aide certificate, is a third-degree felony. This can lead to up to 10 years in prison and a $10,000 fine, underscoring the importance of accurate and truthful submissions.

It is imperative for nurse aides and their employers to meticulously follow the instructions when completing and submitting the Texas Nurse Aide Registry Form 5506-NAR. Understanding and addressing these common misconceptions ensures compliance with the requirements, facilitating a smoother recertification process.

Key takeaways

When filling out the Texas 5506-NAR form, Certified Nurse Aides (CNAs) must follow specific steps and provide accurate information to ensure their certification is correctly verified and processed. Below are key takeaways to guide you through this process:

  • Section 1 must be completed by the Nurse Aide: Ensure all information is filled out correctly and sign the form to verify that the provided information is accurate.
  • Employer Verification is Crucial: Section 2 requires completion and notarization by your employer. Without this, the form will be considered incomplete.
  • Email Submission: Completed forms, along with the required documents, should be sent to nurseaideregistry@hhs.texas.gov for processing.
  • Check your CNA Certificate Status Online: Use the link provided (https://emr.dads.state.tx.us/DadsEMRWeb/) to verify the status of your CNA certification at any time.
  • Stay Informed about In-service Education: Awareness and adherence to in-service education requirements are necessary. These requirements, including completion of HHSC courses in infection control and proper use of PPE annually, are subject to audit.
  • Know the Consequences of False Information: Tampering with or falsifying the form is considered a third-degree felony, with penalties including up to 10 years in prison and a $10,000 fine.
  • Understand Your Rights: You have the right to request and be informed about the information HHSC collects about you, review this information, and request corrections if inaccuracies are found.
  • Documentation is Key: Keep a record of all submitted forms and correspondence with the Texas Nurse Aide Registry to ensure a smooth verification and recertification process.

This comprehensive approach to completing and submitting the Texas 5506-NAR form is designed to assist Nurse Aides in maintaining their certification and staying compliant with Texas Health and Human Services Commission (HHSC) requirements. Following these steps carefully will help prevent delays or issues in the recertification process.

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