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Outline

The Texas 5506 Nar form serves as a crucial document for individuals seeking to verify their employment as Certified Nurse Aides (CNAs) in the state of Texas. This form is divided into two main sections, each designed to gather specific information. Section 1 requires the nurse aide to provide personal details such as name, contact information, and certification number, along with a declaration regarding their employment history and compliance with training requirements. The nurse aide must also confirm their status concerning any disqualifying misconduct and complete in-service education requirements. Section 2 is designated for the employer to verify the nurse aide’s employment, including the duration of service and any known misconduct. This section must be notarized to ensure authenticity. Upon completion, the form must be submitted via email to the Texas Nurse Aide Registry, accompanied by any necessary documentation. It is important to note that incomplete submissions will be returned without action, emphasizing the need for thoroughness. Additionally, the form outlines the legal implications of tampering with government records, underscoring the seriousness of providing accurate information. Resources for verifying certification status and accessing additional forms are also provided, ensuring that nurse aides have the necessary tools to comply with state regulations.

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: [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:

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 [email protected]

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 Name Fact Description
Form Purpose The Texas Nurse Aide Registry Form 5506-NAR is used for employment verification of Certified Nurse Aides (CNAs).
Completion Requirement Section 1 must be filled out by the Nurse Aide, including personal information and a signature to verify accuracy.
Employer Verification Section 2 requires completion by the employer, including notarization of the employer's signature.
Email Submission The completed form must be emailed to the Texas Nurse Aide Registry at [email protected].
In-Service Education Nurse Aides must complete 24 hours of in-service education within the past two years, subject to audit.
Legal Consequences Falsifying a government record, such as this form, is a third-degree felony, punishable by up to 10 years in prison.
Governing Law This form is governed by the Texas Health and Safety Code, specifically §250.006.

Detailed Guide for Filling Out Texas 5506 Nar

Filling out the Texas Nurse Aide Registry Form 5506-NAR requires careful attention to detail. After completing the form, you will need to ensure that your employer verifies your employment and notarizes their signature. Once all sections are complete, the form must be submitted to the Texas Nurse Aide Registry for processing.

  1. Section 1: Nurse Aide Information
    • Provide your full name (Last, First, Middle) and maiden name if applicable.
    • Fill in your mailing address, including street or P.O. Box, city, state, and ZIP code.
    • Enter your Social Security number and email address.
    • Include your daytime phone number with area code.
    • Select your sex and enter your date of birth.
    • Input your Certified Nurse Aide (CNA) certificate number.
  2. Verification of Requirements for Nurse Aide Recertification
    • Indicate whether you are listed on the Employee Misconduct Registry (EMR) as unemployable.
    • Answer if you have been convicted of a criminal offense as per Texas Health and Safety Code, §250.006, and provide the date if applicable.
    • Confirm if you have completed 24 hours of in-service education in the past two years.
    • State whether you have completed an HHSC course in infection control and proper use of personal protective equipment (PPE) in the past 24 months.
  3. Signature
    • Sign and date the form to verify that all information is correct.
  4. Section 2: Employer Verification
    • Provide the employer's name or company name and their daytime phone number with area code.
    • Fill in the employer's mailing address, including street or P.O. Box, city, state, and ZIP code.
    • Specify the dates of employment and confirm that no disqualifying misconduct is known.
    • Include any comments if necessary.
    • The employer must sign and date the form.
    • Ensure the employer's signature is notarized.
  5. Final Steps
    • Double-check that all information in Section 1 is complete and accurate.
    • Confirm that the employer has notarized their signature in Section 2.
    • Email the completed form and any required documents to [email protected].

Obtain Answers on Texas 5506 Nar

  1. What is the Texas 5506 Nar form?

    The Texas 5506 Nar form is an employment verification document required for Nurse Aides in Texas. It is used to verify employment history and ensure compliance with the regulations set forth by the Texas Nurse Aide Registry.

  2. Who needs to complete this form?

    This form must be completed by Nurse Aides who are seeking to verify their employment history as part of the recertification process. Both the Nurse Aide and their employer must provide information to complete the form.

  3. What information is required from the Nurse Aide?

    The Nurse Aide must fill out their personal details, including:

    • Name
    • Mailing address
    • Social Security number
    • Email address
    • Date of birth
    • CNA certificate number

    Additionally, the Nurse Aide must answer questions regarding their criminal history and in-service education completion.

  4. What does the employer need to provide?

    The employer must complete Section 2 of the form, which includes verifying the employment of the Nurse Aide. This section requires the employer's signature, which must be notarized.

  5. How do I submit the completed form?

    Once both sections are completed and signed, the form should be emailed to the Texas Nurse Aide Registry at [email protected].

  6. What happens if the form is incomplete?

    The Texas Nurse Aide Registry will return any incomplete requests without action. It is essential to ensure all required information and signatures are provided before submission.

  7. Can I verify my CNA certification status?

    Yes, you can verify your CNA certification status by visiting the Texas Health and Human Services website at this link.

  8. What are the consequences of tampering with this form?

    Tampering with or attempting to falsify this form is a serious offense. It is classified as a third-degree felony, which can result in up to 10 years in prison and a fine of $10,000.

  9. What if I need to correct my information?

    You have the right to request and be informed about the information that the Texas Health and Human Services Commission obtains about you. If you find any incorrect information, you can request a correction by contacting the Nurse Aide Registry at 512-438-2050.

  10. Where can I find additional resources?

    Additional resources, including a list of approved in-service education programs and downloadable forms, can be found on the Texas Health and Human Services website at this link.

Common mistakes

Filling out the Texas 5506 Nar form can be a straightforward process, but many people make common mistakes that can delay their application. One significant 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. Leaving any section blank can lead to the form being returned without action, wasting valuable time.

Another mistake involves the signature verification. Applicants must sign Section 1 to confirm that the information provided is correct. Some individuals forget this crucial step, which can result in rejection of the application. It is essential to double-check that the signature is present before submitting the form.

In Section 2, the employer must also provide their signature and have it notarized. A frequent oversight is neglecting to have the employer's signature notarized. This requirement is mandatory, and without it, the application will not be processed. Ensuring that the employer understands this step can help avoid unnecessary delays.

Many applicants also overlook the requirement for in-service education. The form asks if the individual has completed 24 hours of in-service education in the past two years. Failing to answer this question accurately can lead to complications. It’s important to keep records of any training completed to provide proof if needed.

Another common error is not providing a valid email address or daytime phone number. These contact details are crucial for communication regarding the application. If the information is incorrect or missing, the Nurse Aide Registry may not be able to reach the applicant for further clarification or updates.

Lastly, some individuals do not follow the instructions for submitting the form. The completed form must be emailed to the Texas Nurse Aide Registry. Failing to send it to the correct email address can result in a delay or loss of the application. Always verify the submission details to ensure everything is sent correctly.

Documents used along the form

The Texas 5506 Nurse Aide Registry Form is essential for nurse aides seeking recertification. Along with this form, several other documents may be required to ensure a complete application. Each of these documents serves a specific purpose in verifying the qualifications and employment history of the nurse aide.

  • Employment Verification Letter: This letter, provided by the employer, confirms the nurse aide's employment duration and the nature of their work. It serves as a formal acknowledgment of the aide's role and responsibilities within the facility.
  • In-Service Education Certificates: Nurse aides must complete a specified number of hours in continuing education. These certificates demonstrate compliance with the training requirements necessary for recertification.
  • Criminal Background Check: A background check may be required to ensure that the nurse aide has no disqualifying criminal offenses. This document helps maintain the safety and integrity of care provided to patients.
  • Employee Misconduct Registry (EMR) Verification: This verification confirms that the nurse aide is not listed as unemployable on the EMR. It is crucial for ensuring that the aide has not been involved in misconduct that would prevent them from working in the field.

Gathering these documents alongside the Texas 5506 Nurse Aide Registry Form is vital for a successful recertification process. Each document plays a role in verifying the qualifications and integrity of the nurse aide, ensuring they meet the standards required for their profession.

Similar forms

  • Texas Nurse Aide Registry Form 5506-NAR: This form is essential for verifying employment and certification for Nurse Aides in Texas. It includes sections for personal information and employer verification, similar to other employment verification forms.
  • Employment Verification Form: Commonly used across various industries, this form confirms an employee's job title, dates of employment, and responsibilities. Like the 5506-NAR, it requires signatures from both the employee and employer.
  • Background Check Authorization Form: This document allows employers to conduct background checks on potential hires. Similar to the 5506-NAR, it gathers personal information and requires the individual's consent.
  • W-2 Form: Used for reporting annual wages and tax withholdings, this form is similar in that it verifies employment history and earnings. Both documents serve important roles in employment verification.
  • I-9 Employment Eligibility Verification: This form is used to confirm an employee's identity and eligibility to work in the U.S. Like the 5506-NAR, it requires personal information and signatures from both parties.
  • Certification Renewal Application: Similar to the 5506-NAR, this document is used by professionals to renew their certifications. It requires proof of continued education and employment verification.
  • Professional License Application: This application is necessary for individuals seeking a professional license in various fields. It collects personal information and employment history, much like the Nurse Aide Registry Form.

Dos and Don'ts

When filling out the Texas 5506 Nar form, keep the following tips in mind:

  • Do complete all information in Section 1 accurately.
  • Do sign Section 1 to verify that your information is correct.
  • Do ensure your employer notarizes their signature in Section 2.
  • Do email the completed form to the Texas Nurse Aide Registry.
  • Don't leave any required fields blank.
  • Don't submit the form without the necessary documents.

Following these guidelines will help ensure your application is processed smoothly. Take your time, double-check your entries, and avoid any mistakes that could delay your certification.

Misconceptions

Misconceptions about the Texas 5506 Nar form can lead to confusion and delays in processing. Here are six common misunderstandings:

  • It's only for new applicants. Many believe the form is solely for new nurse aides. In reality, it’s also essential for recertification and employment verification.
  • Employer signature isn't necessary. Some think they can submit the form without their employer’s signature. However, Section 2 must be completed and notarized by the employer.
  • In-service education is optional. There’s a misconception that in-service education hours are not mandatory. In fact, you must complete 24 hours every two years to remain eligible.
  • Submitting incomplete forms is acceptable. Many assume that they can send incomplete forms and address issues later. The Texas Nurse Aide Registry will return any incomplete requests without action.
  • Verification of CNA certification is automatic. Some believe their certification status is automatically verified. You must actively verify your status through the provided link.
  • All forms can be submitted by mail. It’s a common myth that mailing the form is sufficient. The completed form must be emailed to the Texas Nurse Aide Registry for processing.

Key takeaways

Filling out the Texas Nurse Aide Registry Form 5506-NAR is an important step for nurse aides seeking employment verification and recertification. Here are some key takeaways to keep in mind:

  • Complete Section 1: Ensure all information in Section 1 is filled out accurately. This includes your name, contact information, and CNA certificate number.
  • Employer Verification: Section 2 must be completed by your employer. This section requires notarization, so be sure to arrange that before submission.
  • Email Submission: After completing both sections, email the form to the Texas Nurse Aide Registry at [email protected].
  • In-Service Education: You need to have completed 24 hours of in-service education within the last two years to meet recertification requirements.
  • Criminal Background: Be prepared to disclose any convictions that fall under Texas Health and Safety Code, §250.006, as this information is crucial for your application.
  • Verification Links: Use the provided links to verify your CNA certification status and to find approved in-service education programs.
  • Right to Review Information: You have the right to request and review the information that the Texas Health and Human Services Commission collects about you.

By following these steps, you can ensure that your application process goes smoothly and that you remain compliant with state regulations.