N.H. Admin. Code § Hcp 304.02

Current through Register No. 50, December 12, 2024

Section Hcp 304.02 - Application for Initial Registration as Hearing Aid Dealer

(a) Each applicant for registration as a hearing aid dealer shall provide the following on or with an "Application for Hearing Aid Dealer Registration" form to the board:

(1) The applicant's name, home address, and telephone number;

(2) The applicant's date of birth;

(3) The name and the business address of the applicant, as follows:

a. If an individual, the name under which the person intends to conduct business;

b. If a partnership, the name and business address of each member thereof, and the name under which the business is to be conducted; and

c. If a corporation, the name of the corporation and the name and business address of each of the officers of the corporation;

(4) The place or places, including the complete address or addresses, where the business is to be conducted;

(5) A description of the applicant's education;

(6) A list of the applicant's hearing aid dealer licenses held, including each state in which licensure is held;

(7) The length of time the applicant has been practicing as a hearing aid dealer;

(8) Whether the applicant has ever been refused a license as a hearing aid dealer by any licensing body, and if so, the name of the body, the date of denial, and the reasons for denial;

(9) Whether the applicant has ever been convicted of a felony or misdemeanor that has not been annulled by a court of competent jurisdiction and, if so, the name of the court, the detail of the offense, the date of conviction and the sentence imposed;

(10) Documentation that the applicant has met all of the educational requirements as detailed in the requirements as set forth in Hcp 304.03;

(11) A description of the training program required by Hcp 304.04, including the beginning and ending dates;

(12) A certification separately signed by the applicant indicating that the application is true, correct, and complete to the best of the applicant's knowledge and belief;

(13) The applicant's Social Security number as required by RSA 161-B:11, VI-a;

(14) The applicant's signature and date of signature; and

(15) Payment of the application fee in the amount specified in Hcp 306.01 which, if by check, shall be made payable to "Treasurer, State of New Hampshire."

(b) The applicant shall also:

(1) Arrange to have a certified copy of the National Institute for Hearing Instrument Studies (IHS) International Licensing Examination results sent directly to the board; and

(2) Provide documentation that the applicant has passed the New Hampshire written and practical examinations as set forth in Hcp 304.04.

(c) If an applicant is unable to provide the documentation of passing either or both examinations referred to in (b) above, the applicant shall so state on the application and agree to sit for each missing examination at the earliest offering of such examination.

N.H. Admin. Code § Hcp 304.02

Derived From Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12112, Effective 2/21/2017, Expires 2/21/2027.