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The 5509-NAR form is an important document for nursing facilities and skilled nursing facilities in Texas, designed to maintain compliance with state regulations governing nurse aides. This form serves as a method to certify the employment status of nurse aides and ensures that these individuals meet the necessary recertification requirements. Employers must list all nurse aides who have worked at their facility since the last annual report. They need to verify that these aides have completed in-service education and infection control courses, and that they do not appear on the Employee Misconduct Registry. Each employer is permitted to submit this form only once a year, making accuracy and timeliness crucial. The form requires specific information, including the facility's name, contact details, and the employment history of each nurse aide. If any aide cannot meet verified requirements, a separate form, the 5506-NAR, must be completed. By adhering to these guidelines, facilities help ensure high standards of care and compliance within the Texas healthcare system.

5509 Nar Example

Form 5509-NAR

September 2021-E

Texas Nurse Aide Registry

Facility Nurse Aide Employment Verification

General Instructions

1.Complete facility/employer information requested at the bottom of this page. Repeat the facility/employer name and date of completion on each additional page submitted. A nurse aide may not complete this form for the facility/ employer.

2.List all nurse aides who have been employed with you since your last annual report that met the renewal requirements below. Nursing facilities (NF) and skilled nursing facilities (SNF) are required to submit a list of nurse aide employees on an annual basis, per Texas Standards for Nurse Aides, 26 TAC §556.9.

3.Do not submit Form 5509-NAR (complete list of employees) more than once in a 12-month period.

4.Dates of employment must be indicated in mm/dd/yyyy format. If an individual is still employed, do not leave end date blank. Indicate with either ‘present’ or ‘current’ in the end date box.

5.You may electronically duplicate the format of this document; however, you must include all fields/columns in the order presented on this document.

6.Email the completed form to the Texas Nurse Aide Registry at: nurseaideregistry@hhs.texas.gov.

Facility or Employer Name:

Facility or Employer's Mailing Address:

Facility Representative Name and Title:

Area Code and Phone No.:

Area Code and Fax No.:

Signature – Facility Representative

Date Form Completed

I certify that all individuals listed on this form meet/met the following recertification requirements.

Has completed 24 hours of in-service education in the past two years.

Has completed an HHSC course in infection control and proper use of personal protective equipment (PPE) every year.

Is not listed as unemployable on the Employee Misconduct Registry (EMR).

Has not been found to have a conviction of a criminal offense listed in Texas Health and Safety Code §250.006.

Signature – Facility Representative

Date Form Completed

If the facility or employer cannot verify the requirements above, then the facility or employer and the nurse aide must complete Form 5506-NAR, Employment Verification.

Facility or Employer Name:

Form 5509-NAR

Page 2 / 9-2021-E

Date Form Completed:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Last Name:

First Name:

MI:

Social Security No.:

Nurse Aide No.:

Start Date:

Address:

 

 

City, State, and ZIP Code:

End Date:

Form Characteristics

Fact Name Description
Purpose The 5509-NAR form is used for reporting nurse aide employment verification to the Texas Nurse Aide Registry.
Annual Requirement Nursing facilities (NF) and skilled nursing facilities (SNF) must submit this form annually in accordance with Texas Standards for Nurse Aides, 26 TAC §556.9.
Submission Frequency Facilities are prohibited from submitting the form more than once every 12 months.
Date Format Employment dates should be noted in the mm/dd/yyyy format. Use 'present' for current employees.
Certification Requirements Employers must certify that listed nurse aides meet specific renewal criteria, including 24 hours of education and no criminal convictions under Texas Health and Safety Code §250.006.

Guidelines on Utilizing 5509 Nar

Filling out the 5509-NAR form can seem intimidating at first. However, with a clear understanding of each step, you can easily complete it. This form is essential for maintaining compliance with Texas regulations regarding nurse aide employment verification. Following these instructions will guide you through the whole process smoothly.

  1. At the bottom of the first page, fill in the Facility or Employer Name.
  2. Provide the Facility or Employer's Mailing Address.
  3. Write the Facility Representative Name and Title in the designated space.
  4. Include the Area Code and Phone Number for the facility.
  5. If applicable, provide the Area Code and Fax Number.
  6. Have the Facility Representative sign and indicate the date the form was completed.
  7. Begin listing all nurse aides employed since your last annual report. For each aide, fill in their Last Name, First Name, and Middle Initial.
  8. Enter their Social Security Number and Nurse Aide Number next.
  9. Indicate the Start Date of their employment in mm/dd/yyyy format.
  10. Provide the Address, City, State, and ZIP Code for each aide.
  11. For the End Date, if the aide is still employed, write 'present' or 'current'. If they are no longer employed, indicate the date.
  12. Repeat the last three steps for each nurse aide being reported, ensuring you do not exceed the allowable number of submissions within a 12-month period.
  13. Once you have completed the form, email it to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.

Remember to double-check the accuracy of your entries before submission. A carefully filled-out form will streamline verification and help maintain compliance with nursing regulations in Texas.

What You Should Know About This Form

What is Form 5509-NAR used for?

Form 5509-NAR is employed by nursing and skilled nursing facilities in Texas to verify the employment and continuing education of nurse aides. This form is required to demonstrate compliance with the Texas Standards for Nurse Aides and ensures that the aides meet recertification requirements.

Who is responsible for completing Form 5509-NAR?

The facility representative of the nursing or skilled nursing facility is responsible for completing this form. Nurse aides may not complete the form on behalf of their employers.

How often must Form 5509-NAR be submitted?

Facilities must submit this form only once within a 12-month period. It acts as a comprehensive report ensuring that all employed nurse aides continue to meet the necessary qualifications.

What information is required on Form 5509-NAR?

The form requires details such as the facility's information, the name and contact of the facility representative, and a list of all nurse aides employed since the last annual report. Each aide's employment status, including start and end dates, should also be accurately documented.

In what format should employment dates be entered?

Employment dates must be entered in the format of mm/dd/yyyy. If a nurse aide is currently employed, 'present' or 'current' should be written in the end date box instead of leaving it blank.

How can the completed form be submitted?

The completed Form 5509-NAR should be sent electronically via email to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov. This ensures efficient processing of the information submitted.

What are the recertification requirements that must be verified on Form 5509-NAR?

The facility must certify that each listed nurse aide has completed a minimum of 24 hours of in-service education within the last two years, has undergone an infection control training and PPE usage course annually, is not found on the Employee Misconduct Registry, and has no convictions under Texas Health and Safety Code §250.006.

What should be done if the facility cannot verify compliance with the requirements?

If verification cannot be established, the facility and the nurse aide will need to jointly complete Form 5506-NAR, which serves as an alternative employment verification document.

Common mistakes

Filling out the 5509-NAR form is a critical responsibility for facilities employing nurse aides. Yet, many individuals make common mistakes that can lead to unnecessary complications. One significant error occurs when the facility or employer information is incomplete. Failing to provide accurate names or mailing addresses can hinder communication and processing delays.

Another mistake is incorrectly listing the employment dates. The format requires mm/dd/yyyy, and not adhering to this can lead to confusion. If a nurse aide is still employed, it’s essential to indicate this by writing “present” or “current” as the end date. Leaving it blank can cause problems in verifying employment, leading to issues with the registration.

People often misunderstand the submission policies for the form, too. Submitting Form 5509-NAR multiple times within a 12-month period is not allowed. This can create unnecessary paperwork and complicate the records, possibly resulting in delays in compliance checks.

It’s also common to overlook the certification statements that confirm the nurse aides meet recertification requirements. This includes ensuring they have completed the required 24 hours of in-service education and relevant courses every year. Neglecting to include this information can lead to penalties for the facility.

Another frequent oversight involves the required signature. Not obtaining the facility representative’s signature can render the form invalid. It is crucial to include their name, title, and date of completion properly. Without a valid signature, the form may be rejected, prompting the need for resubmission.

Lastly, some individuals fail to email the completed form to the correct email address. Ensuring the form reaches the Texas Nurse Aide Registry is vital. Sending it to the wrong recipient can cause significant delays in processing. Thus, confirming the email address before sending is essential for a smooth experience.

Documents used along the form

The 5509-NAR form serves as a crucial document for nursing facilities and skilled nursing facilities in Texas to manage the employment verification of nurse aides. Alongside this form, several other documents also play an important role in maintaining compliance with state regulations. Each document supports the processes required for staffing and certification, ensuring that nurse aides meet the necessary qualifications.

  • Form 5506-NAR: This form is used when a facility cannot verify the recertification requirements for a nurse aide. Both the facility and the nurse aide must complete this form to affirm their eligibility for employment.
  • Form 5510-NAR: This document serves as an application for new nurse aides seeking certification. It gathers pertinent information about the aide’s qualifications and previous training to determine compliance with Texas standards.
  • Employee Misconduct Registry (EMR) Check: This is a register that nursing facilities must consult to verify that nurse aides are not listed as unemployable due to prior misconduct. Regular checks help maintain a safe environment for vulnerable populations.
  • In-Service Education Documentation: Facilities are required to maintain records of the 24 hours of in-service education that nurse aides must complete every two years. These records serve as proof of ongoing education and skill updating for the aides.

Collectively, these documents, including the 5509-NAR form, ensure that nursing facilities operate within the regulatory framework established by the state of Texas. By fulfilling these requirements, facilities contribute to the overall quality of care provided to patients and uphold the integrity of the healthcare system.

Similar forms

The 5509 Nar form is an important document for nursing facilities that track the employment status and compliance of nurse aides. Several other forms share similarities with it, as they serve related purposes in employment verification and compliance documentation. Here are ten such documents:

  • Form 5506-NAR: This form is used for employment verification when the facility cannot confirm a nurse aide's compliance with required standards. Like the 5509-NAR, it collects personal and employment information.
  • Form 672: Often utilized in caregiver settings, this document assists in tracking training and certification updates for healthcare staff, ensuring continuing education compliance.
  • Form W-2: Issued by employers for tax reporting, this form includes essential employment details. Both forms underscore the importance of recording accurate employment information.
  • Form I-9: This document verifies a new employee’s identity and eligibility to work in the U.S. In both cases, verifying employment as part of compliance is essential.
  • Form 1099-MISC: Similar to Form W-2, this form is used to report payments to contract workers. Each serves to document the employment relationship, just in different contexts.
  • OIG Exclusion List Verification: This is an essential check for healthcare facilities to ensure hiring compliance. Both the 5509-NAR and the exclusion list verification serve to uphold regulatory standards.
  • State Background Check Forms: These forms are crucial for verifying that potential employees do not have disqualifying convictions, similar to the compliance checks mentioned in the 5509-NAR.
  • Continuing Education Tracking Forms: Used by many healthcare employers to ensure staff complete necessary training. Like the 5509-NAR, these help maintain compliance in education standards.
  • Health Care Provider Credentialing Forms: These verify that healthcare employees meet specific qualifications and standards, mirroring the compliance aspect of the 5509-NAR.
  • Employee Orientation Checklists: Utilized to ensure new hires are thoroughly onboarded and compliant with facility policies. Both forms focus on documenting essential employee information for regulatory purposes.

Dos and Don'ts

Here are six things to do and not to do while filling out the 5509-NAR form:

  • Complete the facility/employer information at the bottom of each page.
  • List all nurse aides employed since your last report.
  • Use the correct date format of mm/dd/yyyy for employment dates.
  • Submit the form only once within a 12-month period.
  • Email the completed form to the Texas Nurse Aide Registry.
  • Ensure the certification requirements for each aide are met before submission.

Things to avoid:

  • Do not submit the form more than once a year.
  • Avoid leaving the end date blank for currently employed aides.
  • Do not exclude any required fields or columns when duplicating the form.
  • Do not allow a nurse aide to complete the form for the facility.
  • Avoid submitting incorrect or incomplete information.
  • Do not forget to repeat the facility/employer name on each subsequent page.

Misconceptions

Misconceptions can often create confusion and hinder understanding, especially regarding specific forms like the 5509-NAR. Here are nine common misconceptions about this form:

  • My employer can complete the form on my behalf.

    In fact, the instructions specify that a nurse aide may not complete this form for their facility or employer.

  • Only new employees need to be listed on the form.

    This is not accurate. The form should include all nurse aides who have been employed since the last annual report and have met renewal requirements.

  • I can submit the form multiple times in a year if needed.

    In reality, the form should not be submitted more than once in a 12-month period.

  • Using 'N/A' is sufficient if an aide is still employed.

    This is incorrect. If a nurse aide is currently employed, the end date should be marked with either 'present' or 'current'.

  • Electronic duplication of the form format is not allowed.

    On the contrary, you may electronically duplicate the format as long as all fields and columns are included in the specified order.

  • I can email the form to any address.

    This is misleading. The form must be emailed specifically to the Texas Nurse Aide Registry at the designated email address provided on the form.

  • There are no educational requirements for listing employees.

    This is false. A facility representative must certify that all listed individuals have completed specific educational requirements.

  • The form does not need a signature from the facility representative.

    Contrarily, the form requires the signature of a facility representative to validate the information provided.

  • All past employees must be listed regardless of their status.

    This is not true. Only employees who have met renewal requirements since the last report should be included on the list.

Key takeaways

  • The 5509-NAR form must be completed by the facility or employer, not by the nurse aide themselves.
  • Facilities must list all nurse aides who have worked since the last annual report and met specified renewal requirements.
  • Only submit the 5509-NAR form once in a 12-month period to avoid redundancy.
  • Make sure to indicate employment dates in the correct format, using mm/dd/yyyy; if the aide is still employed, use 'present' or 'current' for the end date.
  • Each page must include the facility or employer's name and the date of completion.
  • After filling out the form, it should be emailed to the Texas Nurse Aide Registry at the designated address.
  • Ensure all listed nurse aides fulfill recertification requirements, including in-service education and compliance with infection control training.