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Indiana emt reciprocity

Indiana state form 19634 2026

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The document outlines the process for verifying the Emergency Medical Services (EMS) status of applicants seeking reciprocity for certification or licensing in Indiana. It includes instructions for both state agencies and applicants, detailing required documents and steps to complete the verification process.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Part I with your personal information, including your full name, maiden name, address, telephone number, driver’s license number, date of birth, and the level of EMS certification/license you are applying for.
Next, enter your certification/license number in the designated field.
Proceed to Part II where the Emergency Medical Services Certification/Licensing Agency will complete their section. Ensure they provide details such as the type of certification/license issued, issuance date, and expiration date.
Answer the questions regarding course instruction standards and any previous revocations or suspensions of your certification/license.
Finally, ensure that all required documents are attached before submitting the form back to the Indiana Office of EMS via fax or email as instructed.

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How to fill out an Indiana state withholding form?

Print or type your full name, Social Security number or ITIN and home address. Enter your Indiana county of residence and county of principal employment as of January 1 of the current year. If you did not live of work in Indiana on January 1 of the current year, enter not applicable on the line(s).

What is the state form 39530 in Indiana?

A General Affidavit is used when the vehicle is assembled from parts on hand and/or from parts that have been purchased (receipts required). Physical Inspection of a Vehicle or Watercraft State Form 39530. Must be completed by a law enforcement officer. Inspection must be done on all major parts.

How to get a paramedic license in Indiana?

To become a Paramedic in the state of Indiana you must: Complete and EMR training from a state-approved training center, be CPR trained, Pass NREMT, be a US citizen, and Pass a background check.

Does Indiana have state tax withholding?

TIDs are required for paying state taxes and withholding taxes. Withholding of county income tax is required in all 92 Indiana counties. Departmental Notice #1 details the income tax withholding rates for Indiana counties and explains how to withhold taxes. Indianas withholding tax rate is 3.23%.

What is a WH 3 form in Indiana?

Indiana Annual Withholding Reconciliation Form WH-3 Form WH-3 is an Annual Withholding Reconciliation used to report the total income taxes withheld from employees/contractors and taxes remitted to the state. Its also used to claim an overpayment refund or pay if the taxes are underpaid.

indiana paramedic reciprocity

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Does Indiana have a state income tax form?

Indiana Form IT-40 Personal Income Tax for Residents. Indiana Form IT-40PNR Personal Income Tax for Nonresidents. Indiana Form IT-2440 Disability Retirement Deduction.

How to get EMT reciprocity in Indiana?

The applicant must submit State Form 19634, Verification of EMS Status for Reciprocity, to his/her state; and the responding state must send State Form 19634 directly to the Indiana Office of Emergency Medical Services. 3. Paramedics must submit a copy of the ACLS certification with this application.

Does Indiana have a state withholding form?

Indiana Form WH-4, Employees Withholding Exemption County Status Certificate, should be completed by all resident and nonresident employees having income subject to Indiana state and/or county income tax. The form may be downloaded from the Indiana Department of Revenue Withholding Tax Forms website .