Form 5509-NAR at a glance
What it is: Form 5509-NAR is the Texas Nurse Aide Registry Facility Nurse Aide Employment Verification.
Where and when to file: Email the completed form to the Texas Nurse Aide Registry at: nurseaideregistry@hhs.texas.gov.
A filled-in Form 5509-NAR example: a nursing facility completes page 1
How to fill out Form 5509-NAR, box by box
Facility or Employer information
Complete the facility/employer information requested at the bottom of page 1. Repeat the facility/employer name and date of completion on each additional page submitted. A nurse aide may not complete this form for the facility/employer.
Enter the Facility or Employer Name, the Facility or Employer's Mailing Address, the Facility Representative Name and Title, the Area Code and Phone No. and the Area Code and Fax No.
Sign and date the form
The Facility Representative signs on the Signature - Facility Representative line and enters the Date Form Completed.
Signing certifies that all individuals listed on this form meet/met the following recertification requirements.
Has completed 24 hours of in-service education in the past two years. Has completed an HHSC course in infection control and proper use of personal protective equipment (PPE) every year. Is not listed as unemployable on the Employee Misconduct Registry (EMR). Has not been found to have a conviction of a criminal offense listed in Texas Health and Safety Code §250.006.
List of nurse aides
List all nurse aides who have been employed with you since your last annual report that met the renewal requirements.
For each nurse aide, enter Last Name, First Name, MI, Social Security No., Nurse Aide No., Start Date, Address, City, State, and ZIP Code, and End Date.
Dates of employment must be indicated in mm/dd/yyyy format. If an individual is still employed, do not leave end date blank. Indicate with either 'present' or 'current' in the end date box.
More rules for Form 5509-NAR
Nursing facilities (NF) and skilled nursing facilities (SNF) are required to submit a list of nurse aide employees on an annual basis, per Texas Standards for Nurse Aides, 26 TAC §556.9. Do not submit Form 5509-NAR (complete list of employees) more than once in a 12-month period.
You may electronically duplicate the format of this document; however, you must include all fields/columns in the order presented on this document.
If the facility or employer cannot verify the recertification requirements, then the facility or employer and the nurse aide must complete Form 5506-NAR, Employment Verification.
Common questions about Form 5509-NAR
Where do I file it?
Email the completed form to the Texas Nurse Aide Registry at: nurseaideregistry@hhs.texas.gov.
Sources
[1] Form 5509-NAR (September 2021-E), Texas Nurse Aide Registry Facility Nurse Aide Employment Verification, Texas Health and Human Services Commission (the Official source link on this page).
