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Blank Texas 5506 Nar PDF Template

The Texas Nurse Aide Registry Form 5506-NAR is an essential document for individuals seeking to verify their employment as nurse aides in Texas. This form not only confirms employment history but also ensures compliance with state regulations regarding nurse aide certification. Completing the form accurately is crucial for maintaining your certification and avoiding potential issues with the Texas Health and Human Services Commission.

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Contents

Form Example

Texas Nurse Aide Registry	Form 5506-NAR
Texas Nurse Aide Registry	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?		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

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.

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Common mistakes

Incomplete Information: Many applicants fail to fill out all required fields in Section 1. Ensure that every piece of information, including your full name, mailing address, and Social Security number, is provided.
Missing Signature: Some individuals forget to sign Section 1. Your signature is crucial as it verifies that the information you provided is accurate.
Employer Verification Issues: Applicants often overlook the need for their employer to complete Section 2. This section must be filled out by the facility program director or the actual employer.
Notarization Neglect: A common mistake is failing to have the employer's signature notarized. This step is essential for the validity of the form.
Incorrect Dates: Some applicants mistakenly enter incorrect employment dates. Ensure that the dates reflect the actual period of employment as a nurse aide.
Omitting Required Documents: Incomplete requests may be returned without action. Be sure to include all necessary documents, such as in-service education certificates, if required.
Failure to Verify Certification: Applicants sometimes neglect to verify their CNA certification status before submitting the form. This verification is a critical step in the process.

Key takeaways

Filling out and using the Texas 5506-NAR form is an essential step for nurse aides seeking certification verification. Here are some key takeaways to keep in mind:

Complete Section 1: As the nurse aide, you must fill out all information in Section 1 accurately and sign it to confirm its correctness.
Employer Verification: Section 2 requires your employer to verify your employment. This section must be completed by the program director or official keeper of records.
Email Submission: After completing the form, email it to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.
Check Certification Status: Use the provided link to verify your Certified Nurse Aide (CNA) certification status: Texas EMR.
In-Service Education: Be aware that you need to complete 24 hours of in-service education every two years. Keep your certificates handy, as they may be audited.
Notarization Requirement: The employer's signature in Section 2 must be notarized. This step is crucial for the form's acceptance.
Legal Consequences: Understand that tampering with this form or falsifying any information is a serious offense, potentially leading to severe legal penalties.
Right to Information: You have the right to request and review any information the Texas Health and Human Services Commission obtains about you. You can also request corrections to any inaccuracies.

By following these guidelines, you can ensure a smoother process in obtaining your nurse aide certification verification in Texas.

⇓ Texas 5506 Nar PDF

Steps to Using Texas 5506 Nar

Completing the Texas 5506 Nar form is an essential step for nurse aides seeking recertification. This process requires attention to detail and the cooperation of your employer. Once you have filled out the necessary sections and obtained the required verification, you will submit the form via email to the Texas Nurse Aide Registry.

Gather your personal information. You will need your full name, mailing address, social security number, email address, daytime phone number, sex, date of birth, and CNA certificate number.
Complete Section 1. Fill in all the required fields, ensuring accuracy. Sign the form to verify that the information you provided is correct.
Employer verification. Provide the form to your employer, who will complete Section 2. This section must be filled out by the facility program director or the official keeper of records.
Employer signature. Your employer must sign and date the form, and their signature must be notarized.
Review the form. Ensure that all information is complete and accurate in both sections. Check that your employer has notarized their signature.
Email the completed form. Send the filled-out form and any required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.

After submitting the form, you can verify your CNA certification status using the provided link. Be prepared to provide additional documentation if requested by the Texas Health and Human Services Commission. Following these steps carefully will help ensure a smooth recertification process.