Section He-C 401.05 - Initial Application Requirements for Designated Caregivers(a) Applicants for a designated caregiver registry identification card shall submit a completed "Caregiver Application" form to the department, which includes the following: (1) Indication whether it is an initial or renewal application, and if an initial application, whether the applicant submitted the criminal record authorization form and fee to the NH department of safety;(2) The following applicant information:e. Optional e-mail address;g. Physical address, if different than mailing address;(3) The following information for each qualifying patient the applicant will be assisting with the therapeutic use of cannabis, which shall not exceed 5 qualifying patients, except that additional qualifying patients shall be allowed, up to a maximum of 9, if both the designated caregiver and the additional qualifying patients each live greater than 50 miles from the nearest ATC:c. Physical address, if different than mailing address, except that if the qualifying patient is experiencing homelessness this shall not be required; and(4) A signed and dated attestation of the following acknowledgements:a. "I understand that my Registry ID Card is valid for one year, unless a shorter duration is indicated. I must renew my card every year by submitting another application.";b. "I understand that if I am notified of a denial I have 30 days to appeal the decision from the date of the notice, and that if a hearing request is not made within that timeframe then I will have waived my right to a hearing and the action of the Department shall become final.";c. "I understand that I may not possess, between myself and my Qualifying Patient(s), more than two ounces of usable cannabis per Qualifying Patient.";d. "I understand that as a Designated Caregiver I am not permitted to use therapeutic cannabis, unless I am also a Qualifying Patient, and may be subject to criminal penalties if I do so.";e. "I understand that as a Designated Caregiver I am not permitted to possess any cannabis for purposes other than its therapeutic use as permitted by RSA 126-X.";f. "I understand that I may not be in possession of therapeutic cannabis in any of the following locations: (1) the building and grounds of any preschool, elementary, or secondary school, which are located in an area designated as a drug free zone; (2) a place of employment, without the written permission of the employer; (3) any correctional facility; (4) any public recreation center or youth center; or (5) any law enforcement facility.";g. "I understand that in the event of my Qualifying Patient's death, I will, within 5 days of the death: (1) notify the Department of the death; and (2) either request that the local law enforcement agency remove any remaining cannabis or dispose of the remaining cannabis in a manner that is specified in RSA 126-:2, IVX.";h. "I understand that if I am found to be in possession of therapeutic cannabis outside of my home and I am not in possession of my Registry ID Card, I may be subject to a fine of up to $100.";i. "I understand that any person(s) who makes a fraudulent representation to a law enforcement official of any fact or circumstance relating to the therapeutic use of cannabis to avoid arrest or prosecution shall be guilty of a violation and may be fined $500, which shall be in addition to any other penalties that may apply for making a false statement to a law enforcement officer or for the use of cannabis other than use undertaken pursuant to this RSA 126-X."; j. "I understand that the protections conferred by RSA 126-X for the therapeutic use of cannabis are applicable only within New Hampshire.";k. "I understand that I must be in compliance with RSA 126-X and with the administrative rules adopted thereunder, and that the Department may revoke my Registry ID Card for any violation of any provision of RSA 126-X or the administrative rules adopted thereunder."; andl. "I understand that I, by possessing therapeutic cannabis, and my Qualifying Patient, by using therapeutic cannabis, may be denied rights and privileges by federal agencies including, but not limited to, those related to employment such as driving a commercial vehicle, those related to owning, possessing, or purchasing a firearm and ammunition, those related to federal housing, those related to immigration and naturalization, or the inability to pass a security clearance.";(5) A signed and dated certification that:a. The applicant agrees to act as the designated caregiver for the qualifying patient named in the application;b. The facts as stated in the application are accurate to the best of the applicant's knowledge and belief; andc. The applicant understands that any false statements made on the application are punishable as unsworn falsification under RSA 641:3;(6) A signed and dated pledge not to divert cannabis to anyone who is not allowed to possess cannabis pursuant to RSA 126-X, acknowledgement that diversion of cannabis shall result in revocation of their registry identification card, and acknowledgement that the sale of cannabis to anyone who is not a qualifying patient or a designated caregiver is punishable as a class B felony with a sentence of a maximum term of imprisonment of not more than 7 years, and a fine of not more than $300,000, or both, in addition to other penalties for the illegal sale of cannabis; and(7) Voluntary demographic information, as follows:c. Employment and income;(b) In addition to the materials in (a) above, for each applicant the department shall also receive the results of a state and federal criminal history records check from the division of state police, department of safety. An application shall not be considered complete without the results of a state and federal criminal history records check.(c) In order for the department to receive the results of a state and federal criminal history records check, an applicant shall submit to the division of state police the following:(1) A criminal history record information authorization form, as provided by the division of state police, which authorizes the release of any felony convictions to the department;(2) A complete set of electronic fingerprints taken by a qualified law enforcement agency or an authorized employee of the department of safety; and(d) In the event that, after 2 attempts, the applicant's electronic fingerprints are invalid due to insufficient pattern, the department shall, in lieu of the criminal history records check, accept the results of police clearances showing no felony convictions from every city, town, or county where the person has lived during the past 5 years, including any out-of-state residency, received from the division of state police.(e) The applicant shall submit the documents in (a) above to: NH Department of Health and Human Services
Therapeutic Cannabis Program
29 Hazen Drive
Concord, NH 03301
N.H. Admin. Code § He-C 401.05
Adopted byVolume XXXIV Number 33, Filed August 14,2014, Proposed by #10646, Effective 8/1/2015.Amended by Volume XXXV Number 45, Filed November 12, 2015, Proposed by #10964, Effective 11/2/2015, Expires 11/2/2025.Amended by Volume XLI Number 32, Filed August 12, 2021, Proposed by #13220, Effective 7/1/2021, Expires 7/1/2031.