The Georgia Reinstatement Nursing form is an essential application for individuals seeking to reinstate their nursing license in the state of Georgia. This form requires applicants to provide detailed information regarding their professional history, continuing education, and any reasons for the lapse in licensure. Ensure that all sections are completed accurately to avoid delays in processing your application.
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The Georgia Reinstatement Nursing form is an essential document for those seeking to regain their nursing license after it has lapsed. This application process requires careful attention to detail, as incomplete submissions will be returned without review. Applicants must provide a variety of information, including personal details, the reason for license expiration, and a summary of professional activities since the last renewal. A critical component of the application is the consent form for a background check, which must be signed and submitted alongside the application. Additionally, candidates are required to pay a non-refundable application fee of $150. The form also outlines the continuing professional education (CPE) requirements necessary for reinstatement. Specifically, applicants need to demonstrate they have completed 40 hours of CPE per year, with a minimum of 20% in accounting and auditing subjects, and at least 80 of those hours must have been earned within the 24 months prior to applying for reinstatement. Failure to meet these educational requirements will result in the application being returned. Overall, understanding and adhering to the guidelines set forth in the Georgia Reinstatement Nursing form is crucial for a successful application process.
APPLICATION FOR REINSTATEMENT OF LICENSE
GEORGIA STATE BOARD OF ACCOUNTANCY
237 Coliseum Drive
Macon, GA 31217
Phone (478) 207-2440
www.sos.georgia.gov/plb/accountancy/
Please read the instructions carefully and be familiar with the laws and rules governing the practice of accountancy in the State of Georgia. Visit the following website for information: www.sos.georgia.gov/plb/accountancy/. Board Rule 20-10-.04 concerning reinstatement of licensure is enclosed within this application.
The Board cannot process incomplete applications. If any item is missing, incomplete or incorrect, your application cannot be reviewed by the Board. Please review the check list below and this application before you submit it to ensure that all information and documentation is complete and correct.
Consent Form for background check. This form must be completed, signed and returned with your application or your complete application will be returned.
Activities Since Last Renewal. Field must be completed. Answers could be: did not need, out of country, sick, etc.
Non-refundable application fee of $150.00 (check or money order) made payable to Georgia State Board of Accountancy
Reason For Failing To Renew. Field must be completed.
Required completed hours of continuing professional education for reinstatement.
See the table below on left for the required number of hours required for reinstatement of license. If you do not have the required hours, your complete application will be returned and you have 90 days from the date of the notification letter to re-submit the application without an additional fee.
CPE Requirements:
You are required to have obtained 40 hours of CPE per year, not to exceed 160 hours. You may be required to show proof of this only if randomly audited.
See Board Rule 20-11-.02 (1) for more information regarding CPE.
A minimum of 20% of total hours must be in accounting and auditing subjects and at least 80 hours must have been earned during the 24 months immediately preceding the date of the Reinstatement Application. (Reinstatement Application must be signed the date it is mailed.) For instance: If you sign the Reinstatement Application on 1/1/08, your 80 hours (with 16 hrs. in A&A) would be from 1/1/06 to 1/1/08. Hours earned in 2008 and 2009 may also be used for the 12/31/09 renewal year. CPE requirements must be completed before submitting the Reinstatement Application.
As information:
If your license lapsed 12/31/07, you may use hours from 1/1/06 and forward for all hours except for the recent 80 hours in the previous 24 months (with 20% in A&A).
If you license lapsed 12/31/05, you may use hours from 1/1/04 and forward for all hours except for the recent 80 hours (with 20% in A&A) in the previous 24 months.
C:\Users\dmickler\AppData\Local\Temp\22 Application for Reinstatement of License_6D05F61.doc
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For Board Use Only
Date of Review
Approved
Disapproved
Fee Paid
Check #
Date
Applicant #
Receipt
#
237 Coliseum Drive - Macon, Georgia 31217 - (478) 207-2440
www.sos.state.ga.us/plb/accountancy/
(Application will be returned if all questions are not answered)
Reinstatement Fee: $150.00 (Non-Refundable)
License Type
PLEASE PRINT OR TYPE
Certified Public Accountant
License No.
Date License Lapsed
1.Name on License
First
Middle
Last
2. SSN*
3. Date of Birth
*THIS INFORMATION IS AUTHORIZED TO BE OBTAINED & DISCLOSED TO STATE & FEDERAL AGENCIES PURSUANT TO O.C.G.A. SECTION 19-11-1 & O.C.G.A.SECTION 20-3-295, 42 U.S.C.A. SECTION 551 & 20 U.S.C.A.SECTION 1001.
4.Physical Address
Number and Street (P.O. Box not acceptable)Apt. No.City/StateZip
5.
Mailing Address
(if different than Street address)
Street, P.O. Box
Apt. No.
City/State
Zip
6.
Telephone Number Day
(
)
Telephone Number Evening
7.Present Employer
8.Business Address
Number and Street
City
State
9.Internet e-mail address
Since the date of your last renewal, have you been convicted of a felony or misdemeanor (other than a minor traffic violation), or entered a plea of guilty, nolo contendere, or sentenced under the “First Offender Act’, or been sanctioned by this or another state board or agency? If Yes, check below and attach copy of conviction, plea or sanction. DUI and DWI are not minor traffic offenses.
NO
YES
(If YES, attach a certified copy of conviction, plea or sanction)
ACTIVITIES SINCE LAST RENEWAL:
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REASON FOR FAILING TO RENEW:
APPLICANT AFFIDAVIT:
I hereby swear and affirm that all information provided in this application is true and correct to the best of my knowledge and belief. I further swear and affirm that I have read and understand the current state laws and rules and regulations of the Board for which I am applying for licensure and I agree to abide by these laws and rules.
By executing this affidavit under oath, as an applicant for a professional license, as referenced in O.C.G.A. § 50-36- 1, administered by the Professional Licensing Boards Division, the undersigned applicant also verifies one of the following with respect to his/her application for a public benefit (check one):
1)
I am a United States citizen. Please submit a copy of your current Secure and Verifiable
Document(s) such as driver’s license, passport, or document as indicated on the Board’s
website.
2)
I am not a United States citizen, but I am either a legal permanent resident of the United States or I
am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an
alien number issued by the Department of Homeland Security or other federal immigration agency.
Please submit a copy of your current immigration document(s) which includes either your Alien number or your I-94 number and, if needed, SEVIS number.
The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit.
In making the above representations under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. I also understand that any failure to make full and accurate disclosures may result in disciplinary action by the Board for which I am applying for licensure.
Executed in
(city),
(state).
Signature of Applicant
Printed Name of Applicant
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE
DAY OF
_, 20
NOTARY PUBLIC My Commission Expires:
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IMPORTANT: Please see the following for continuing professional education report & page 8 for copy of rule #20-10- 04.
CONTINUING PROFESSIONAL EDUCATION REPORT
NAME :
THIS PAGE MUST HAVE TOTALS FOR A & A HOURS AND ALL OTHER SUBJECTS HOURS. APPLICATION WILL BE RETURNED IF THESE COLUMNS ARE NOT COMPLETE. THE BOARD WILL NOT TOTAL YOUR CPE HOURS.
(See page 8 for copy of rule #20-10-.04 (REINSTATEMENT) effective January 25, 2001 for current requirement.) YOU ARE NOT REQUIRED TO SUBMIT DOCUMENTATION OF CONTINUING EDUCATION HOURS UNLESS YOU ARE AUDITED.
School, Firm or Organization Conducting Program
Title of Program or Description of Content
Principal Instructor
Dates Attended
Accounting & Auditing
All Other Subjects
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Sub Total Hours
TOTAL HOURS CLAIMED ABOVE 2 COLUMNS MUST BE COMPLETED
I certify under penalty of perjury to the truth and accuracy of all statements, answers and representations made in this report.
Signature
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OFFICE OF SECRETARY OF STATE
PROFESSIONAL LICENSING BOARDS DIVISION
Macon, Georgia 31217
(478) 207-2440
CONSENT FORM
I hereby authorize the State Board of Accountancy (“Board”) to receive any Georgia criminal history record information pertaining to me which may be in the files of any state or local criminal justice agency in Georgia.
Full Name (Print)
Physical Address
(P.O. Boxes NOT Accepted)
Sex
Race
Date of Birth
Social Security Number
One of the following must be checked:
This authorization is valid for 90/180/
(circle one) days from date of signature.
I,
give consent to the Board to perform periodic
criminal history background checks for the duration of my licensure with this state.
Special licensure provisions (check if applicable):
Working with mentally disabled
Working with elder care
Working with children
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APPLICANT: PLEASE CHECK THE FORM OF IDENTIFICATION BELOW THAT YOU POSSESS. RETURN THIS FORM ALONG WITH A COPY OF YOUR APPROPRIATE DOCUMENTATION.
Name
Secure and Verifiable Documents Under O.C.G.A. § 50-36-2
Issued August 1, 2011 by the Office of the Attorney General, Georgia
The Illegal Immigration Reform and Enforcement Act of 2011 (“IIREA”) provides that “[n]ot later than August 1, 2011, the Attorney General shall provide and make public on the Department of Law’s website a list of acceptable secure and verifiable documents. The list shall be reviewed and updated annually by the Attorney General.” O.C.G.A. § 50-36-2(f). The Attorney General may modify this list on a more frequent basis, if necessary.
The following list of secure and verifiable documents, published under the authority of O.C.G.A. § 50-36-2, contains documents that are verifiable for identification purposes, and documents on this list may not necessarily be indicative of residency or immigration status.
A United States passport or passport card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A United States military identification card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A driver’s license issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the
Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
An identification card issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A tribal identification card of a federally recognized Native American tribe, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer. A listing of federally recognized Native American tribes may be found at: http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A United States Permanent Resident Card or Alien Registration Receipt Card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
An Employment Authorization Document that contains a photograph of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A passport issued by a foreign government [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A Free and Secure Trade (FAST) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
A NEXUS card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card [O.C.G.A. §50-36-2(b)(3); 22 CFR § 41.2]
A driver’s license issued by a Canadian government authority [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration Services (USCIS) (Form N-560 or Form N-561) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration Services (USCIS) (Form N-550 or Form N-570) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
In addition to the documents listed herein, if, in administering a public benefit or program, an agency is required by federal law to accept a document or other form of identification for proof of or documentation of identity, that document or other form of identification will be deemed a secure and verifiable document solely for that particular program or administration of that particular public benefit. [O.C.G.A. § 50- 36-2(c)]
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RULES OF THE GEORGIA STATE BOARD OF ACCOUNTANCY
20-10-.04 REINSTATEMENT
20-10-.04 Reinstatement. Amended.
(1)An application for reinstatement of an expired permit shall be accompanied by:
(a) A reinstatement fee of $150.00; and
(b)Evidence satisfactory to the Board, of the completion of continuing professional education as specified below:
1.Forty hours of continuing professional education for each year since the last renewal of the permit or since the initial issuance of the permit, whichever is less, up to a maximum of 160 hours.
2.At least twenty percent of the total hours required must be earned in accounting and auditing subjects.
3.At least 80 of the continuing professional education hours must have been completed during the 2-year period immediately preceding the date of application for reinstatement.
4.The hours required may be counted toward fulfilling the continuing professional education requirements for the next biennial renewal, if they were completed during the applicable period for renewal.
5.No carryover hours may be used to satisfy continuing professional education requirements for reinstatement of an expired permit.
(c)The Board may, however, accept in lieu of the continuing professional education requirements other evidence of continued competency including, but not limited to, the passing of an examination approved by the Board.
(2)In considering the application for reinstatement the Board may conduct an investigation of the applicant to determine, among other things, if the applicant engaged in the practice of public accountancy during the period that the applicant was not the holder of a live permit to practice public accountancy. Based on the results of that investigation, the Board may deny the application for reinstatement.
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Filling out the Georgia Reinstatement Nursing form requires careful attention to detail. Ensuring all sections are completed accurately is essential, as any missing or incorrect information may delay the processing of your application. Once you have filled out the form, you will need to submit it along with the necessary documentation and fees to the Georgia State Board of Accountancy.
What is the purpose of the Georgia Reinstatement Nursing form?
The Georgia Reinstatement Nursing form is used by individuals who wish to reinstate their nursing license after it has lapsed. This application allows the Georgia State Board of Accountancy to review your qualifications and ensure you meet the necessary requirements to practice nursing again.
What documents do I need to submit with my application?
Along with the completed application form, you must include:
What are the continuing education requirements for reinstatement?
To qualify for reinstatement, you must have completed 40 hours of continuing professional education (CPE) for each year your license was inactive, up to a maximum of 160 hours. At least 20% of these hours must be in accounting and auditing subjects. Importantly, you need to have earned at least 80 of these hours within the 24 months prior to submitting your application.
What happens if my application is incomplete?
If your application is incomplete, it will be returned to you without being reviewed. This includes missing or incorrect information. To avoid delays, carefully review the checklist provided with the application to ensure all required information and documentation is included.
How long do I have to resubmit my application if it is returned?
If your application is returned due to missing information or documentation, you have 90 days from the date of the notification letter to resubmit it without incurring an additional fee. It’s crucial to address any deficiencies promptly to avoid further complications.
Filling out the Georgia Reinstatement Nursing form can be a straightforward process, but many applicants make common mistakes that can lead to delays or rejections. One frequent error is leaving fields blank. Every section of the application must be completed. If you skip even one question, your application will be returned. This includes essential information like your name, license number, and reasons for failing to renew.
Another common mistake is not providing the correct payment. The application requires a non-refundable fee of $150. Some applicants forget to include this payment or use the wrong method, which can lead to immediate rejection. Always ensure that your check or money order is made out to the Georgia State Board of Accountancy.
Many applicants also fail to complete the consent form for a background check. This form is crucial, and without it, your application will not be processed. Make sure to sign and return this form along with your application. It’s a simple step that can save you a lot of time.
Inaccurate reporting of continuing education hours is another mistake. Applicants must have completed the required hours of continuing professional education (CPE) before submitting the application. If you don’t meet the CPE requirements, your application will be returned. Ensure that you have the necessary documentation ready, even if you are not required to submit it unless audited.
Some people overlook the importance of the activities section. This field must be filled out with relevant information about what you have been doing since your last renewal. Leaving it blank or providing vague answers can lead to confusion and result in your application being returned.
It’s also vital to provide accurate contact information. Many applicants forget to include their current phone numbers or email addresses. If the board needs to reach you for any reason, having up-to-date contact information is essential.
Failing to sign the application is another common oversight. The application must be signed on the date it is mailed. If you forget this step, your application will be considered incomplete.
Not verifying the required CPE hours can lead to issues as well. Applicants often miscalculate their hours or fail to check if they meet the specific requirements for accounting and auditing subjects. Double-check your totals to avoid any discrepancies.
Lastly, many applicants do not read the instructions carefully. Each section has specific requirements and guidelines. Taking the time to understand these can help you avoid mistakes and ensure a smoother application process.
When applying for the Georgia Reinstatement Nursing form, several other documents and forms are often required to ensure a smooth reinstatement process. Each of these documents serves a specific purpose in verifying the applicant's qualifications and compliance with state regulations.
Gathering these documents is essential for a successful application process. Ensuring that all forms are completed accurately and submitted on time can significantly reduce the chances of delays in reinstating your nursing license.
When filling out the Georgia Reinstatement Nursing form, there are several important dos and don'ts to keep in mind. Following these guidelines can help ensure that your application is processed smoothly.
Misconceptions about the Georgia Reinstatement Nursing form can lead to confusion and delays in the application process. Here are five common misconceptions, along with clarifications to help applicants better understand the requirements.
This is not true. The Georgia State Board of Accountancy requires that all applications be complete. If any item is missing or incorrect, the application will be returned without review.
While it is correct that documentation is not required unless audited, it is essential to have completed the required CPE hours before submitting the application. Failure to meet these requirements can result in the application being returned.
The application fee of $150.00 is non-refundable. Regardless of the outcome, applicants will not receive a refund if their application is incomplete or denied.
This is incorrect. A completed and signed consent form for a background check must accompany the application. Without it, the application will be returned.
In fact, a minimum of 20% of total CPE hours must be in accounting and auditing subjects. This requirement is crucial for reinstatement and must be met to avoid application rejection.
When filling out the Georgia Reinstatement Nursing form, it's important to keep several key points in mind:
By following these guidelines, you can help ensure that your application process goes smoothly.