Section Ahp 601.04 - Application For Temporary Licensure(a) The application form for temporary licensure shall be the "Application for Temporary Initial Licensure" form approved by the office of licensed allied health professionals board of directors on April 1, 2019.(b) The application form shall be provided by the board.(c) Applicants for temporary licensure shall submit the following to the board: (1) A completed application for full licensure;(2) A completed "Application for Temporary Initial Licensure" form, revised 4/1/2019, for which the applicant shall:a. Complete the entire form using a keyboard or by printing the information legibly in ink; andb. Complete all sections of the entire form or designate them as not applicable;(3) Proof the applicant holds an unencumbered license from either Connecticut, Rhode Island, Massachusetts, Maine, New York, or Vermont, as required by RSA 328-F:18, VI; and(4) A fee in accordance with Ahp 301.02.(d) The application form in (c)(2) above shall have the applicant's notarized signature pursuant to Ahp 601.07.(e) Pursuant to RSA 161-B:11, VI-a, the applicant shall furnish his or her social security number on the application form.N.H. Admin. Code § Ahp 601.04
Derived From Volume XXXIX Number 10, Filed March 7, 2019, Proposed by #12725, Effective 2/15/2019, Expires 2/15/2029.Amended by Volume XXXIX Number 37, Filed September 12, 2019, Proposed by #12846, Effective 8/13/2019, Expires 8/13/2029.