The Texas Nurse Aide Registry Form 5506-NAR is a critical document for individuals seeking to verify their employment as nurse aides in Texas. This form requires detailed information from both the nurse aide and their employer, ensuring compliance with state regulations. Proper completion and submission of this form are essential for maintaining certification and employment eligibility in the healthcare field.
The Texas 5506 Nurse Aide Registry Form, commonly referred to as the 5506-NAR, plays a crucial role in the recertification process for Certified Nurse Aides (CNAs) in Texas. This form is divided into two main sections, each serving distinct purposes. In the first section, the nurse aide must provide personal details, including their name, contact information, and CNA certificate number. It is essential for the nurse aide to confirm the accuracy of this information by signing the form. Additionally, this section includes critical questions regarding the aide's employment history and compliance with in-service education requirements. For example, the form asks whether the aide has completed 24 hours of in-service education in the past two years and whether they have undergone annual training in infection control and the proper use of personal protective equipment. The second section is dedicated to employer verification. Here, the employer must confirm the aide's employment status and the nature of their duties, while also ensuring that the information is notarized. This verification process is vital, as the Texas Nurse Aide Registry will not process incomplete submissions. It is important to note that tampering with this form or any related government record is a serious offense, carrying significant legal penalties. Understanding the requirements and procedures outlined in the 5506-NAR is essential for nurse aides seeking to maintain their certification and continue providing care in Texas.
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?
If yes, give date of conviction.
Have you completed 24 hours of in-service education in the past two years?
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
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.:
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
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.
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.
Como Subir Archivos a Your Texas Benefits - If your financial situation involves assets over $10,000 or multiple vehicles, you must disclose this information.
Houston Eviction - Allows landlords to specify whether rent is subsidized by the government and the amount, as part of the eviction process for non-payment.
Adoption Records Texas - Combined fees for the various services offered can be paid in one check or money order to DSHS – Vital Statistics.