Form 5509 nar-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the facility/employer information at the bottom of the first page, including the Nurse Aide Registry (NAR) unique employer ID. Ensure this information is repeated on any additional pages submitted.
3. List all nurse aides employed since your last annual report. Include their last name, first name, middle initial, and social security number in the designated fields.
4. Indicate whether you are submitting an Annual List or a Partial List by checking the appropriate box.
5. Complete the certification section confirming that all listed individuals meet recertification requirements. This includes verifying education hours and checking for any disqualifying criminal offenses.
6. Finally, ensure that a facility representative signs and dates the form before submission. You can then fax or mail it as instructed.

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