5509 Form Details

Form 5509 NAR is a form that is used to report the nondeductible expenses of investing in a Passive Activity. This includes real estate and rental activity. The form is also used to calculate the amount of loss that can be deducted from taxable income on your tax return. There are specific instructions that must be followed in order to complete this form correctly. Make sure you consult with a tax professional if you have any questions about how to use this form.

The listing contains specifics of the form 5509 nar. There, you'll discover the details about the PDF you would like to fill out, like the likely time to complete it and also other particulars.

QuestionAnswer
Form NameForm 5509 Nar
Form Length2 pages
Fillable?Yes
Fillable fields137
Avg. time to fill out27 min 58 sec
Other namesnar form 5509, fee downloadable form 5509 nar, 5509 nar, nurse aide employment verification form

Form Preview Example

Texas Department of Aging

Form 5509-NAR

and Disability Services

March 2014-E

Texas Nurse Aide Registry

Facility Nurse Aide Employment Verification

General Instructions:

1.Complete facility/employer information requested at the bottom of this page, including the Nurse Aide Registry (NAR) unique employer ID. Repeat the facility/employer name, unique ID and date of completion on each additional page submitted. A nurse aide may not complete this form for the facility/employer.

2.List all nurse aides who have been employed with you since your last annual report. 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, 40 TAC §94.9.

3.Do not submit Form 5509-NAR (complete list of employees) more than once in a 12-month period.

4.You are invited to use this form to submit individual names or partial lists to update/renew nurse aides whose registration will expire before your next annual list is due. If you are submitting a form for this reason, please check Partial List in the appropriate box.

5.Form 5509-NAR is available for download at www.dads.state.tx.us/providers/NF/credentialing/nar/forms.html ; however, for security reasons we cannot accept forms transmitted via email. You can fax forms to 512-438-2051.

6.You may electronically duplicate the format of this document; however, you must include all fields/columns in the order presented on this document. Form must be completed in ink or typed.

7.Mail form to: Nurse Aide Registry, Mail Code E-414, P.O. Box 149030, Austin, TX 78714-9030.

Facility/Employer Name

 

 

 

 

 

Annual List

Partial List

 

 

 

 

Facility/Employer's Mailing Address

 

NAR Unique ID:

 

 

 

FP

 

Facility Representative Name and Title (please print)

 

 

 

 

 

FN

 

 

 

 

 

Area Code and Telephone No.

Fax Area Code and Telephone No.

 

 

 

 

 

Signature – Facility Representative

Date Form Completed

I certify that all individuals listed on this form meet/met the following recertification requirements.

Has completed 24 hours of in-service education in the past 2 years.

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.

Signature – Facility Representative

Title

Date Form Completed

If the facility/employer cannot verify the requirements above, then the facility/employer and the nurse aide must complete Form 5506-NAR, Employment Verification.

Facility/Employer Name

 

 

Form 5509-NAR

 

 

Page 2 / 03-2014-E

NAR No.:

 

Date Form Completed (mm/dd/yy)

 

 

FP

 

 

FN

 

 

 

 

 

Status

1. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

Status

2. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

3. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

4. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

5. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

6. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

7. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

8. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

9. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

10. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

11. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

Status

12. Last Name

First Name

MI

Social Security No.

 

Nurse Aide No.

Start Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City, State, and ZIP Code

 

End Date (mm/dd/yy)

 

 

 

 

 

 

 

 

 

 

How to Edit Form 5509 Nar

It shouldn’t be a challenge to get form 5509 nar employment verification taking advantage of our PDF editor. Here's how you can successfully make your template.

Step 1: Choose the button "Get form here" to open it.

Step 2: You are now ready to enhance form 5509 nar employment verification. You possess a lot of options with our multifunctional toolbar - it's possible to add, remove, or customize the content material, highlight its specified sections, as well as conduct other sorts of commands.

You should type in the next details to prepare the form 5509 nar employment verification PDF:

form 5509 nar printable blanks to fill out

You should put down your data in the area Facility/Employer Name, NAR No, FP FN, Date Form Completed (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, and End Date (mm/dd/yy).

Completing form 5509 nar printable part 2

You can be expected to write down the data to let the platform prepare the section Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, and End Date (mm/dd/yy).

part 3 to finishing form 5509 nar printable

The Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, End Date (mm/dd/yy), Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, and End Date (mm/dd/yy) area should be used to provide the rights or obligations of both sides.

part 4 to filling out form 5509 nar printable

Finish by taking a look at the following fields and filling them in as required: Status, First Name, Social Security No, Nurse Aide No, Start Date (mm/dd/yy), Address, City, and End Date (mm/dd/yy).

part 5 to completing form 5509 nar printable

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