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Form 5518-NFA, Provisional Licensure Questionnaire Form 5518-NFA, Provisional Licensure Questionnair-2026
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- Click ‘Get Form’ to open it in the editor.
- 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.
- Provide your license information including the state where it was issued and your Nursing Facility Administrator (NFA) number.
- 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.
- Complete the Provisional License Sponsor section by entering the name and license number of your sponsor.
- Sign and date the Applicant's Authorization section to authorize the release of your licensure information.
- If applicable, ensure that Section 2 is completed by the state where you are currently licensed before submitting.
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by R Harrison 1994 Requiring less than 30 seconds to complete, this form was used in all Segment 2 origin and destination surveys. How often do you make this tri per day week