Homepage Blank Texas 5506 Nar PDF Template
Navigation

In ensuring the professional standards and continuous certification of nurse aides in Texas, the Texas 5506-NAR form plays a pivotal role. This document serves as a verification tool for employment and in-service education as part of the recertification process for Certified Nurse Aides (CNAs). Nurse aides are required to fill out and sign Section 1, confirming the accuracy of their provided information, including vital details like contact information, social security number, and specific queries about in-service education and any criminal convictions that could affect their certification. After completion, it's necessary for an employer to verify this data in Section 2, which also needs to be notarized, ensuring due diligence in the nurse's employment verification. Essential for maintaining the high standards expected of healthcare professionals, this form helps the Texas Nurse Aide Registry track compliance with state health regulations, providing links for certificate verification and detailing the consequences of falsification, which is treated as a severe offense under Texas law. The specificity of the form dictates a structured pathway for CNAs to ensure their certification remains in good standing, underlining the importance of accurate information and adherence to state healthcare guidelines.

Preview - 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.

Form Data

Fact Name Description
Form Purpose The Texas 5506-NAR is used for the verification of employment for Nurse Aides in Texas, ensuring they meet recertification requirements.
Submission Instructions Section 1 must be completed by the Nurse Aide and Section 2 by the employer, with the employer's section being notarized before submission via email to the Texas Nurse Aide Registry.
Governing Law The form is governed by the Texas Health and Safety Code, specifically §250.006 for criminal offense regulations and the Texas Government Code (Sections 552.021, 552.023, 559.004) for information rights and correction.
Penalties for Falsification Falsifying or attempting to falsify the 5506-NAR form is considered a third-degree felony, punishable by up to 10 years in prison and a $10,000 fine.
Verification and In-Service Education Nurse Aides must verify that they are not listed on the Employee Misconduct Registry, have no disqualifying criminal convictions, and have completed required in-service education and training in infection control and PPE usage.

Instructions on Utilizing Texas 5506 Nar

Filling out the Texas 5506-NAR form accurately is crucial for certified nurse aides seeking employment verification or recertification. This process involves two sections where the first part requires your details and the second needs verification from your employer. Before emailing the completed form, ensure each step is followed carefully to avoid any delays caused by incorrect or incomplete information.

  1. Enter your full name, including your maiden name if that applies to you, in the fields provided under "Name of Applicant".
  2. In the "Mailing Address" field, write your street address or P.O. Box.
  3. Fill in your city, state, and ZIP code in the respective fields.
  4. Provide your social security number in the space indicated.
  5. Enter your email address and daytime phone number, including the area code.
  6. Select your sex by checking the appropriate box for male or female.
  7. Type your date of birth in the format requested.
  8. Fill in your CNA Certificate No. in the designated space.
  9. Answer "Yes" or "No" to whether you are listed on the Employee Misconduct Registry (EMR) as unemployable.
  10. Indicate whether you have been found to have a conviction of a criminal offense listed in Texas Health and Safety Code, §250.006. If yes, provide the date of conviction.
  11. Confirm if you have completed 24 hours of in-service education in the past two years by marking "Yes" or "No".
  12. Specify if you have completed an HHSC course in infection control and proper use of personal protective equipment (PPE) once each year over the past 24 months by checking "Yes" or "No".
  13. Sign and date the form in the space provided at the end of Section 1 to verify that the information you provided is correct.
  14. Have your employer fill out Section 2, including their name, phone number, mailing address, and certification that you were employed as a nurse aide. They must also sign and date this section.
  15. Ensure your employer's signature is notarized at the bottom of Section 2.
  16. Check that both sections are fully completed and signed appropriately. Any missing information may lead to the form being returned without action.
  17. Email the completed form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.

Once the form is submitted, the Texas Nurse Aide Registry will process your verification. Remember to verify your certificate status and access other necessary forms via the links provided in the form instructions. It's important to keep records of the submission and follow up with the Texas Nurse Aide Registry if you have any concerns about your information or the status of your recertification.

Obtain Answers on Texas 5506 Nar

  1. What is the Texas 5506-NAR Form?

    The Texas 5506-NAR Form, also known as the Employment Verification Form, is a required document for nurse aides in Texas seeking recertification. This form serves as proof of a nurse aide’s employment in a nursing or nursing-related position. It is divided into two sections: the first section should be completed by the nurse aide, and the second by their employer.

  2. How do I complete Section 1 of the form?

    In Section 1, you must provide personal information including your name, mailing address, social security number, and details concerning your certification as a Certified Nurse Aide (CNA). This section also requires you to answer questions about your employment status, criminal background, and in-service education hours. Make sure to sign this section to verify that the information provided is accurate.

  3. What are the requirements for the employer in Section 2?

    The employer must complete Section 2, confirming the employment details of the nurse aide and noting any relevant comments. Importantly, the employer's signature must be notarized at the bottom of this section. The form then needs to be returned to the nurse aide for submission to the Texas Nurse Aide Registry.

  4. How do I submit the form?

    After completing both sections and obtaining the necessary notarization, email the form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov. Make sure the form is fully completed to avoid it being returned without action.

  5. How can I verify my CNA certification?

    You can verify your CNA certification status by visiting https://emr.dads.state.tx.us/DadsEMRWeb/. This link provides up-to-date information regarding your certification status and can be used for verification purposes in employment settings.

  6. Where can I find approved in-service education programs?

    Approved in-service education programs, which are required for recertification, can be found at https://hhs.texas.gov/nar-cbts or https://hhs.texas.gov/nar-approved-inservice. These resources list programs approved by the Texas Health and Human Services Commission (HHSC), ensuring that the in-service hours completed are valid for recertification purposes.

  7. What are my rights regarding the information provided on the form?

    Under sections 552.021, 552.023, and 559.004 of the Government Code, you have the right to request and be informed about the information that the HHSC obtains about you through this form. You are entitled to review this information upon request and have the right to ask HHSC to correct any information deemed incorrect. For more details, you can contact the Nurse Aide Registry directly.

Common mistakes

Filling out the Texas 5506-NAR form, a critical document for nurse aides seeking employment verification, requires careful attention to detail. Unfortunately, mistakes can sometimes occur, leading to unnecessary delays or complications in the verification process. Let's explore nine common pitfalls to avoid when completing this form.

  1. Not completing all information in Section 1: This section must be fully completed by the nurse aide. Skipping any details can cause the form to be returned without action.
  2. Failure to sign Section 1: The nurse aide's signature is a testament to the accuracy of the information provided. Forgetting to sign can invalidate the form.
  3. Omitting the employer's notarization in Section 2: This is a necessary step that confirms the employer's endorsement of the information provided. Missing notarization prevents the form from being processed.
  4. Inaccurate employment dates: Providing incorrect dates of employment can lead to verification errors, potentially affecting the nurse aide's certification status.
  5. Not being aware of the in-service education requirements: Nurse aides must complete certain education requirements, which, if unmet or undocumented, can halt the recertification process.
  6. Failing to check the Employee Misconduct Registry (EMR): Knowing one's status on the EMR is crucial, as being listed as unemployable can disqualify a candidate.
  7. Omitting email correspondence: The form specifies that completed documents must be emailed to the Texas Nurse Aide Registry. Neglecting to do so can delay processing times.
  8. Neglecting to verify certificate status: Nurse aides can check their certification status online. Not doing so might lead to surprises about one's eligibility for recertification.
  9. Forgetting to provide complete contact information: Full contact details support communication needs and further verification, if necessary. Incomplete contact information may lead to processing delays.

Avoiding these common mistakes will smooth the path toward successful form submission and recertification. Being thorough, attentive, and proactive in verifying all requirements are met and all sections are accurately completed ensures nurse aides can advance in their careers without unnecessary obstacles.

Documents used along the form

When assisting with the completion and submission of the Texas Nurse Aide Registry Form 5506-NAR, it is important to be aware of additional forms and documents that may be required or beneficial. These documents ensure that all legal and procedural requirements are met, facilitating a smoother verification or recertification process for nurse aides. Understanding each of these documents will provide clarity and enhance preparedness throughout the process.

  • Form 5505-NAR: Texas Nurse Aide Registry Request for Waiver of Nurse Aide Training and Competency Evaluation - This form is used when a nurse aide is seeking a waiver for the training and competency evaluation requirements. It is essential for those who have equivalent training or are certified in another state and wish to be certified in Texas without undergoing the standard testing process.
  • Form 5508-NAR: Employment Verification for Nurse Aides with Expired Certification - Similar to the 5506-NAR, this form is specifically tailored for nurse aides whose certification has expired. It facilitates the verification of employment required to renew or reinstate their certification.
  • Form 5510-NAR: Nurse Aide Competency Evaluation Registration - This form is used by individuals seeking to schedule their competency evaluation test. It's a critical step for those who have completed their training program and wish to become certified nurse aides in Texas.
  • Criminal History Check: A thorough criminal history check is often required alongside the 5506-NAR form. This ensures that the applicant meets the state's legal requirements for employment as a nurse aide and has not been convicted of offenses that would bar them from certification.
  • In-Service Education Certificates: Documentation of completed in-service education hours is necessary for recertification. These certificates prove that a nurse aide has met the continuing education requirements, including courses in infection control and the proper use of personal protective equipment (PPE).

Understanding and preparing the correct paperwork is essential for a seamless certification or recertification process for nurse aides in Texas. Each form and document plays a critical role in demonstrating eligibility, competency, and adherence to state regulations. Whether seeking initial certification, recertification, or reinstatement, having these documents in order ensures compliance with Texas Health and Human Services Commission (HHSC) requirements. It is advisable to consult with the Texas Nurse Aide Registry for the most current forms and requirements.

Similar forms

  • The Form I-9 Employment Eligibility Verification is similar to the Texas 5506-NAR form because both require verification of eligibility for a specific status; Form I-9 for work eligibility in the United States, and the 5506-NAR for verifying the status of a nurse aide's certification in Texas.

  • W-4 Form, used for tax withholding purposes, also requires personal information and employment status similar to the first section of the Texas 5506-NAR form, where nurse aides provide their personal details and employment verification.

  • The Professional Certification Renewal Application forms found in various professions share similarities with the 5506-NAR, as both involve the confirmation of continuing education and professional standards to maintain certification.

  • Background Check Authorization Form parallels the Texas 5506-NAR form in its requirement for disclosing criminal history to verify eligibility, in this case for recertification as a nurse aide in Texas.

  • The Direct Deposit Authorization Form gathers personal and sensitive information from employees for payroll purposes, akin to the personal detail collection seen in the 5506-NAR form's first section for certification verification.

  • Employee Misconduct Registry Verification Search Form used in Texas for validating an individual's status on the Employee Misconduct Registry is similar to the 5506-NAR's section querying about the applicant's listing on the Employee Misconduct Registry as unemployable.

  • Continuing Education (CE) Verification Form for various professions mirrors the 5506-NAR form where it questions the completion of mandatory educational requirements, an essential step for recertification of nurse aides in Texas.

  • Medical Examination Form required for specific jobs that need health clearance is akin to the 5506-NAR form in its purpose to ensure that an individual is qualified and meets specific requirements, although for the 5506-NAR, the focus is on certification and legal qualifications rather than health.

Dos and Don'ts

When completing the Texas 5506-NAR form, it's essential to pay close attention to detail and ensure that all the required information is accurately presented. To guide you through the process, here's a list of do's and don'ts that should be kept in mind:

Do:
  • Review the instructions carefully before filling out the form to ensure that each section is completed as required.
  • Verify that all personal information in Section 1, including your name, mailing address, and certification number, is correct and up-to-date.
  • Sign and date Section 1 to authenticate that the information provided is accurate.
  • Ensure that the employer completes Section 2, including the verification of employment and notarization of their signature.
  • Provide a current email address for communications with the Texas Nurse Aide Registry.
  • Check the box appropriately to confirm whether you are listed on the Employee Misconduct Registry (EMR) and if you have completed the required in-service education.
  • Before submission, verify that all supporting documents are attached and the form is fully completed to avoid it being returned without action.
Don't:
  • Leave any fields blank in either section; incomplete forms will not be processed.
  • Forget to obtain the employer’s notarized signature in Section 2, as it's crucial for verifying your employment.
  • Omit the date of any convictions if applicable, as honesty is critical for the verification process.
  • Neglect the in-service education requirement; ensure you have completed the necessary hours and can provide documentation if audited.
  • Use outdated contact information that could delay communication with the Texas Nurse Aide Registry.
  • Attempt to submit the form without ensuring all information is correct and verifiable; inaccuracies may lead to delays or rejection.
  • Disregard instructions for emailing the completed form and required documents to the specified address, as failure to do so can result in processing delays.

Misconceptions

Understanding the Texas Nurse Aide Registry Form 5506-NAR is crucial for nurse aides seeking to renew their certification. Yet, there are widespread misconceptions about the form and its requirements. Clarifying these misunderstandings can help nurse aides ensure their recertification process is smooth and successful.

  • Misconception 1: The form can be submitted without employer verification.

    This is incorrect. Section 2 of the form, which requires completion and notarization by the employer, is essential. Without this section duly filled, the Texas Nurse Aide Registry will return the form unprocessed.

  • Misconception 2: Nurse aides can bypass the in-service education requirement.

    In fact, completing 24 hours of in-service education in the past two years is a mandatory requirement. The Texas Nurse Aide Registry subjects this requirement to audits, and nurse aides should be prepared to present their in-service certificates if asked.

  • Misconception 3: Conviction of a criminal offense automatically disqualifies an applicant.

    While certain convictions can lead to disqualification, each case is reviewed individually based on the specifics of the offense as outlined in the Texas Health and Safety Code, §250.006. Applicants must disclose any convictions, but this does not immediately result in disqualification.

  • Misconception 4: You do not need to be listed on the Employee Misconduct Registry to apply.

    The form specifically asks whether you are listed on the Employee Misconduct Registry as unemployable. Being listed can affect your eligibility, and honesty in this section is crucial.

  • Misconception 5: Personal information is optional on the form.

    All fields in Section 1, including personal information such as mailing address, Social Security number, and contact details, are required to ensure your application is processed accurately and in a timely manner.

  • Misconception 6: Only a facility program director can complete Section 2.

    Section 2 can be completed by the facility program director, the official keeper of records, or the actual employer. This provides flexibility and ensures that nurse aides can obtain the necessary verification regardless of their employment situation.

  • Misconception 7: Submitting the form via email is optional.

    The correct and currently the only method for form submission is via email to the specified address: nurseaideregistry@hhs.texas.gov. This ensures a quick processing time and allows for electronic record-keeping.

By understanding and addressing these misconceptions, nurse aides can better navigate the recertification process, ensuring that their application for the Texas Nurse Aide Registry is completed accurately and efficiently.

Key takeaways

Filling out and using the Texas 5506-NAR form is a critical process for nurse aides seeking employment verification or certification verification in Texas. It involves specific steps and requirements that ensure the accuracy and validity of the information provided to the Texas Nurse Aide Registry. Here are key takeaways to guide you through this process:

  • Thoroughly complete Section 1: As a nurse aide, it's essential to fill out all information requested in Section 1 of the form accurately. This includes your personal details, such as your name, contact information, and CNA Certificate Number. Remember to sign the form to verify that the information you've provided is correct. Careful attention to detail in this section helps avoid delays in processing your form.
  • Employer verification is crucial: Section 2 of the form must be completed by your employer. This section serves as the employment verification part, where the employer or facility program director confirms your employment and the nursing-related services you provided. Make sure this section is filled out completely and that your employer notarizes their signature, as this adds a layer of formal verification to your employment status.
  • Email the completed form: Once both sections of the form are completed and you've ensured that all the required documents are attached, email everything to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov. Emailing the form is a secure and efficient way to submit your documents for processing.
  • Check your certification status online: The Texas Nurse Aide Registry provides an online link (https://emr.dads.state.tx.us/DadsEMRWeb/) where you can verify the status of your CNA certification. This tool is useful for both current and prospective employers to confirm your certification status, and for you to ensure that your records are up to date.
  • Understand the importance of in-service education: The form asks if you've completed 24 hours of in-service education in the past two years, including a course in infection control and proper use of personal protective equipment (PPE) every year. These requirements are critical for maintaining high standards of care and ensuring that nurse aides remain informed about the latest practices in their field.

In summary, the Texas 5506-NAR form is an important document for nurse aides in Texas, required for verifying employment and ensuring the accuracy of one's credentials on the state registry. By carefully completing this form and understanding its components, nurse aides can navigate the certification or recertification process more smoothly.

Please rate Blank Texas 5506 Nar PDF Template Form
4.81
Incredible
16 Votes