California CNA and HHA Renewal Application Form
This form is used for the renewal, reactivation, and certification for Certified Nurse Assistants (CNA) and Home Health Aides (HHA) in California. Follow the sections to fill out the required details. All applicable questions must be answered for the application to be processed.
Edit, Download, and Sign the California CNA and HHA Renewal Application Form
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out this form, carefully read each section and provide the necessary information. Ensure all required fields are completed to avoid processing delays. If you need assistance, consult the detailed instructions provided on the reverse of the form.
How to fill out the California CNA and HHA Renewal Application Form?
1
Download the form from the provided link.
2
Fill out all required sections with accurate information.
3
Attach any required supporting documents.
4
Sign and date the form.
5
Submit the form via mail or fax to the provided address or number.
Who needs the California CNA and HHA Renewal Application Form?
1
Certified Nurse Assistants (CNA) needing to renew their certification.
2
Home Health Aides (HHA) needing to renew their certification.
3
CNAs who need to reactivate their certification.
4
Individuals holding dual certification for CNA and HHA.
5
Employers needing to verify employee certification status.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the California CNA and HHA Renewal Application Form along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your California CNA and HHA Renewal Application Form online.
PrintFriendly enables you to easily edit this PDF form with our integrated PDF editor. You can fill out all required fields directly on our platform. Make sure to review and save your edits before submission.
Add your legally-binding signature.
With PrintFriendly, you can effortlessly sign this PDF form using our signature feature. Place your signature electronically in the designated areas. Ensure your signature matches the required sections for the form's acceptance.
Share your form instantly.
PrintFriendly allows you to share the completed PDF form through our platform. Use the share feature to send the form via email or generate a shareable link. Easily distribute the form to necessary parties for further processing.
How do I edit the California CNA and HHA Renewal Application Form online?
PrintFriendly enables you to easily edit this PDF form with our integrated PDF editor. You can fill out all required fields directly on our platform. Make sure to review and save your edits before submission.
1
Open the form on PrintFriendly's PDF editor.
2
Fill in the required fields with accurate information.
3
Attach any necessary documentation.
4
Review your completed form for accuracy.
5
Save and download your edited form.
What are the instructions for submitting this form?
Mail or fax the completed form to the California Department of Public Health (CDPH), Licensing and Certification Program, Aide and Technician Certification Section, MS 3301, P.O. Box 997416, Sacramento, CA 95899-7416. Fax: (916) 552-8785. Email inquiries to: cna@cdph.ca.gov. Ensure all sections are filled out accurately and attach required documents for a smooth process. My advice is to double-check all entries for correctness and completeness before submission to avoid delays.
What are the important dates for this form in 2024 and 2025?
This form needs to be renewed every two years for CNAs and every four years for HHAs, based on the expiration date of your certificate. Ensure timely submission to avoid delinquency.
What is the purpose of this form?
The purpose of this form is to facilitate the renewal or reactivation of certification for Certified Nurse Assistants (CNA) and Home Health Aides (HHA) in California. By maintaining updated certification, healthcare professionals ensure they meet state requirements, which allows them to continue providing quality care. It also helps in keeping the workforce legally compliant and assures employers of their employees' qualifications.
Tell me about this form and its components and fields line-by-line.
- 1. Type of Request: Indicates whether the application is for CNA renewal, HHA renewal, or CNA reactivation.
- 2. Personal Information: Includes fields for last name, first name, public and confidential addresses, social security number, email, date of birth, and phone number.
- 3. Convictions and Licensing Actions: Requires disclosure of any convictions or adverse actions taken against any health-related license or certification.
- 4. Training and Employment Verification: Covers verification of In-Service Training or Continuing Education Units (CEUs) and employment details for CNAs and HHAs.
- 5. Reactivation: For CNA applicants who did not meet renewal requirements and seek reactivation by taking the Competency Evaluation.
- 6. Certification: Requires applicant's signature, date, and declaration of truthfulness under penalty and perjury.
What happens if I fail to submit this form?
Failure to submit this form or provide accurate information could result in the lapse of your certification status. This impacts your legal ability to work as a CNA or HHA.
- Certification Lapse: Your certification will become invalid, and you will be placed on delinquent status.
- Employment Impact: You may not legally present yourself as a certified CNA or HHA, affecting job eligibility.
How do I know when to use this form?
- 1. Certificate Renewal: When your current certificate is expiring and needs renewal.
- 2. Certificate Reactivation: If your certification has lapsed and you need to undergo reactivation processes.
- 3. Dual Certification: When holding dual CNA and HHA certification and renewing both simultaneously.
- 4. New Employment Verification: When starting a new job that requires verification of valid certification.
- 5. Compliance: To remain compliant with state health and safety regulations.
Frequently Asked Questions
How do I start editing this form on PrintFriendly?
Open the form in PrintFriendly's PDF editor and use the tools to fill out the required fields.
Can I sign the form electronically on PrintFriendly?
Yes, you can use the signature feature to sign the form electronically in the designated areas.
What should I do if I make a mistake while editing?
Simply use the undo feature or edit the incorrect information directly in the PDF editor.
How do I save my completed form?
After completing the form, click the save button to download the edited form to your device.
Can I share my completed form directly from PrintFriendly?
Yes, use the share feature to email the form or create a shareable link.
How do I attach necessary documents to the form?
Use the attachment feature in the PDF editor to upload and include additional documents.
Do I need to fill out all sections of the form?
Fill out all required sections. Refer to the instructions to know which sections are applicable to your situation.
What is the importance of providing accurate information?
Accurate information ensures the prompt processing of your application. Incorrect details may lead to delays.
How do I know if my form was successfully submitted?
You will receive a confirmation if you submit via email or fax. Keep a copy of your submission for reference.
Can I use PrintFriendly to print the form for manual submission?
Yes, you can print the edited form for manual submission if required.
Related Documents - CNA/HHA Renewal Form
Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.
Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.
TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.
Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.
Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.
Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.
Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.
MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.
Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.
Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.
Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.
Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.
