Texas Form 5506 Nar PDF Details

Texas Form 5506 NAR is used to report the sale or exchange of certain types of property. This form must be filed within 30 days after the date of the sale or exchange. The information reported on this form can help you avoid paying taxes on the property you sell or exchange. Read on to learn more about Texas Form 5506 NAR and how to file it.

This information can help you understand better the details of the texas form 5506 nar before you start filling it out.

QuestionAnswer
Form NameTexas Form 5506 Nar
Form Length2 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out42 sec
Other names5506 nar form, nurseaideregistry hhsc state tx us, cna renewal texas, texas nurse aide registry

Form Preview Example

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.

How to Edit Texas Form 5506 Nar Online for Free

Our PDF editor can make filling out documents easy. It is quite convenient to enhance the Texas Form 5506 Nar document. Check out these actions if you would like do this:

Step 1: Initially, click the orange "Get form now" button.

Step 2: At this point, you're on the file editing page. You can add information, edit existing information, highlight specific words or phrases, place crosses or checks, add images, sign the document, erase needless fields, etc.

These particular segments will constitute the PDF document that you will be completing:

example of fields in cna renewal form

You have to enter the crucial details in the Yes, Yes, Signature, Nurse, Aide Date, Daytime, Area, Code, and, Phone, No Mailing, Address, Street, or, PO, Box City, State, ZIP, Code and Comments area.

Completing cna renewal form part 2

Write the significant details in day, of Date, Signature, Notary, Public and Date, Commission, Expires area.

Finishing cna renewal form step 3

The Address, and aide, registry, nar, forms field can be used to point out the rights and responsibilities of each party.

part 4 to completing cna renewal form

Step 3: When you click on the Done button, the finalized document is easily exportable to any of your devices. Or alternatively, you will be able to deliver it via mail.

Step 4: Make minimally two or three copies of your form to keep clear of any kind of possible future troubles.

Watch Texas Form 5506 Nar Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .