Get Physical Therapist Assistant Reinstatement Application - Nebraska ... - Dhhs Ne

Filling out the Physical Therapist Assistant Reinstatement Application is an essential step for individuals looking to reinstate their practice. This guide aims to provide clear and step-by-step instructions to assist users in completing the application accurately.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form and open it for completion.
2. In Section A, indicate the reinstatement application fee. Remember that the standard fee is $125. If your reinstatement occurs within 180 days of the expiration date of your certificate, the fee is reduced to $60. Ensure your payment is made payable to the ‘Licensure Unit’.
3. Proceed to Section B, where you will provide your personal information. This section requires your legal name, maiden name (if applicable), present address, and contact details. Note that the information in the first two fields will be public.
4. In Section C, you must disclose any convictions or certification actions. For each inquiry, select 'Yes' or 'No'. If 'Yes' is selected, provide detailed explanations and necessary documentation as specified.
5. Section D requires information about any practice you may have engaged in while your certification was expired or inactive. State whether you practiced, how many days, and provide the business information where applicable.
6. For Section E, complete the continuing competency requirements. Ensure you have completed the Nebraska Law Tutorial with a score of 100% and document your continuing education hours.
7. In Section F, respond to the attestation questions regarding your professional conduct since your last renewal. Explain any 'Yes' answers as required.
8. Finalize your application in Section G by attesting to the information provided and signing where indicated. Make sure all required documentation is prepared for submission.
9. Once complete, you have the option to save the changes, download a copy of your application, print it for your records, or share it if necessary.

Be sure to complete your application online to ensure a smooth reinstatement process.