Form 5518-NFA, Provisional Licensure Questionnaire Form 5518-NFA, Provisional Licensure Questionnair-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section 1: Applicant Information. Fill in your name, maiden name (if applicable), social security number, email address, date of birth, and address details accurately.
  3. Provide your license information including the state where it was issued and your Nursing Facility Administrator (NFA) number.
  4. In the Employment Information section, indicate your employer's name and address. Confirm if you were the administrator of record at this facility and provide dates of employment.
  5. Complete the Provisional License Sponsor section by entering the name and license number of your sponsor.
  6. Sign and date the Applicant's Authorization section to authorize the release of your licensure information.
  7. If applicable, ensure that Section 2 is completed by the state where you are currently licensed before submitting.

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