New Hampshire Code of Administrative Rules
Plc - Executive Director, Office of Professional Licensure and Certification
Chapter Plc 300 - LICENSURE OF REGULATED PROFESSIONS
Part Plc 308 - RENEWALS; CONTINUING EDUCATION
Section Plc 308.06 - Information Required for Renewal Applications

Universal Citation: NH Admin Rules Plc 308.06

Current through Register No. 12, March 21, 2024

The information required by Plc 308.05(b)(1) shall be as follows:

(a) The applicant's profession and the license number and expiration date of the license;

(b) For individuals, the following:

(1) The applicant's full legal name, including any suffix such as "Jr." or "III", and any name(s) under which the applicant holds or has held a professional license;

(2) The applicant's date of birth by month, day, and year;

(3) The applicant's social security number, as required by RSA 161-B:11, VI-a and 42 U.S.C. 666(a)(13);

(4) The applicant's designated email address, home physical address, and home mailing address, if different;

(5) The applicant's home or other personal telephone number;

(6) The name, physical address, and telephone number of the applicant's office or other place of business;

(7) If the applicant routinely practices in more than one location, the name of each such location and, for each:
a. The business address, and telephone number; and

b. Whether the applicant is an employee, a subtenant subletting space, an independent contractor, or the owner of the business;

(8) Whether the applicant is on active military duty or is the spouse of an individual who is on active military duty, and whether the applicant is applying for facilitated licensure; and

(9) Any other profession-specific information required by applicable law, such as proof of certification by, or registration with, a regional or national credentialing organization, to the extent not otherwise covered by this section;

(c) For entities, the following:

(1) The applicant's full legal name as shown on the document(s) that created the entity and each name under which the applicant does business in New Hampshire;

(2) The type of entity the applicant is, such as a corporation, limited liability corporation, professional association, partnership, or other form;

(3) The entity's date and state of formation;

(4) The applicant's primary location address in New Hampshire and New Hampshire mailing address, if different;

(5) The applicant's main telephone number;

(6) The applicant's designated email address;

(7) The name, telephone number, and email address of the individual authorized by the applicant to sign the application and the name, telephone number, and email address of each individual authorized by the applicant to interact with the OPLC regarding the application and any license issued based on the application, if other than the authorized signer; and

(8) Any additional information required for entities by applicable law;

(d) Identification of all states where the applicant is currently licensed and, for each, the date of most recent licensure and status of the license;

(e) A "yes" or "no" answer to the following questions regarding the applicant's background and character, provided that "not previously reported" shall not include anything not required to be submitted by Plc 304.03(e):

(1) Whether during the past 27 months or not previously reported, the applicant has been found guilty of or entered a plea of no contest to any felony or misdemeanor;

(2) Whether during the past 27 months or not previously reported, the applicant has been the subject of any disciplinary action by any professional licensing authority;

(3) Whether during the past 27 months or not previously reported, the applicant has been denied a license or other authorization to practice in any jurisdiction;

(4) Whether during the past 27 months or not previously reported, the applicant has surrendered a license or other authorization to practice issued by any jurisdiction in order to avoid or settle disciplinary charges;

(5) Whether the applicant is now or has any reason to believe that the applicant will soon be the subject of a disciplinary proceeding, settlement agreement, or consent decree undertaken or issued by a professional licensing board of any jurisdiction;

(6) Whether during the past 27 months or not previously reported, any malpractice claim has been made against the applicant;

(7) Whether during the past 27 months or not previously reported, the applicant has, for disciplinary reasons, been put on administrative leave, been fired for cause other than staff reductions from a position at the applicant's place of employment, or had any privileges limited, suspended or revoked in any professional setting;

(8) Whether during the past 27 months or not previously reported, the applicant has been denied the privilege of taking an examination required for any professional licensure; and

(9) Whether during the past 27 months or not previously reported, the applicant has committed any act(s) that would violate the laws and/or rules that govern the practice of the profession in which the applicant is licensed;

(f) Whether the applicant consents to the disclosure to third parties of:

(1) For individuals, any or all of the applicant's contact information; or

(2) For entities, the entity's designated email address; and

(g) For applicants in any health care field, whether the applicant has an ownership interest in any diagnostic or therapeutic service(s) or company(ies), and if so the name and address of each company and the specific diagnostic or therapeutic services provided by the company, to comply with RSA 125:25-c.

Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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