Section He-P 1612.05 - Initial License or Certificate Application Requirements(a) Each applicant for a license or certificate as a lead professional shall comply with the requirements of RSA 130-A, and submit the following to the department: (1) A completed "Lead License or Certification Application" (May 2020) provided by the department for the discipline of lead professional being applied for, certifying the following: "I certify that I have read, understand, and agree to comply with the New Hampshire Lead Poisoning Prevention Rules (He-P 1600) and the Lead Poisoning Prevention Statute (RSA 130-A). I further certify that all information contained herein, including any supplements attached, is true and correct to the best of my knowledge and belief.";
(2) The applicable licensing or certification fee(s) pursuant to He-P 1612.08(a), for the discipline of lead professional being applied for, paid by check or money order, in the exact amount of the fee(s) and made payable to the "Treasurer, State of New Hampshire";(3) An original, current, clear photograph of the applicant, such as a passport photograph; (4) Photocopies of official academic transcripts and/or diplomas issued by the relevant educational institution or a GED, as required by He-P 1612.02;(5) A copy of the course completion certificate for the lead educational program completed in accordance with He-P 1611 for the discipline of lead professional being applied for;(6) With the exception of a lead abatement worker, documentation that the applicant has passed the proficiency examinations required by He-P 1612.04;(7) Documentation, including the name, address, telephone number, and e-mail, if available, of a contact person(s) who can verify all work experience required by He-P 1612.02; (8) A list of all names, trade names, acronyms, and other identifiers used currently or in the past when performing lead hazard reduction activities, lead inspections, or risk assessments;(9) A list of any pending or completed federal, state, or local enforcement actions against the applicant which resulted from lead hazard reduction activities, lead inspections, or risk assessments for the 10 years preceding submission of the application, including:a. Notices of warnings, violations, or administrative fines;b. Administrative orders or consent decrees;c. Notices of license or certification denial, suspension, or revocation; andd. Pending or completed civil or criminal actions involving the applicant; and(10) If applying for a license as a lead inspector or a risk assessor, signed documentation that they agree to provide the department with proof of competency as required by He-P 1612.02(e)(4) or (f) (4).(b) The application required by (a) above shall be notarized. (c) The applicant shall mail or hand-deliver the documents to: Department of Health and Human Services
Division of Public Health Services
Healthy Homes and Lead Poisoning Prevention Program
29 Hazen Drive
Concord, NH 03301
N.H. Admin. Code § He-P 1612.05
#8932, eff 7-6-07; ss by #9986, eff 9-1-11
Amended by Volume XL Number 28, Filed July 9, 2020, Proposed by #13052, Effective 6/11/2020, Expires 6/11/2030