007.33.22 Ark. Code R. 020

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Current through Register Vol. 49, No. 10, October, 2024

Rule 007.33.22-020 - XXV: Licensure Fees

Article XXV:Fees

A. Initial License/Permit

1. Dental License by Examination $150

2. Dental License by Credentials/Reciprocity $1,000

3. Dental Specialty License $300

4. Collaborative Care Permit for Dentists $500

5. Hygiene License by Examination $100

6. Hygiene License by Credentials/Reciprocity $350

7. Collaborative Care Permit I for Hygienists $100

8. Collaborative Care Permit II for Hygienists $150

9. Corporation Registration $25

10. General/Deep Sedation Permit (Dentist) $500

11. Moderate Sedation Permit (Dentist) $150

12. Local Anesthesia Permit (Hygienist) $25

13. Mobile Dental Facility Permit $5,000

14. Exam and Licensing for Dental Assistants $75

B. Renewal

15. Dentist $300

16. Corporation Registration $10

17. Sedation Permit (Dentists) $80

18. Dental Hygienists $100

19. Reinstatement for Dentists and Hygienists $200 plus renewal fee

20. Dental Assistant $50

C. Other

21. Wall Certificate Remake for dentists & hygienists $25

22. NSF (returned) check fee $25

23. Background checks $38.50

D. Fee Waiver

1. Pursuant to Act 725 of 2021, an applicant may receive a waiver of the initial licensure fee, if eligible. Eligible applicants are applicants who:

1) Are receiving assistance through the Arkansas, or current state of residence equivalent, Medicaid Program, the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (SSNP), the Temporary Assistance for Needy Families Program (TEA), or the Lifeline Assistance Program (LAP);

2) Were approved for unemployment within the last twelve (12) months; or

3) Have an income that does not exceed two hundred percent (200%) of the federal poverty income guidelines.

2. Applicants shall provide documentation showing their receipt of benefits from the appropriate State Agency.

1) For Medicaid, SNAP, SSNP, TEA, or LAP, documentation from the Arkansas Department of Human Services (DHS), or current state of residence equivalent agency;

2) For unemployment benefits approval in the last twelve (12) months, the Arkansas Department of Workforce Services, or current state of residence equivalent agency; or

3) For proof of income, copies of all United States Internal Revenue Service Forms indicating applicant's total personal income for the most recent tax year e.g., "W2," "1099," etc.

3. Applicants shall attest that the documentation provided under subsection 2. is a true and correct copy and fraudulent or fraudulently obtained documentation shall be grounds for denial or revocation of license.

007.33.22 Ark. Code R. 020

Adopted by Arkansas Register Volume 48, Number 01, Effective 1/13/2023