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Preview - Ohio Rcb 020 Form
NBRC CREDENTIAL VERIFICATION FORM
OHIO RESPIRATORY CARE BOARD 77 S. High Street, 16th Floor Columbus, Ohio
TO APPLICANT:
The National Board for Respiratory Care, Inc. (NBRC) requires a fee to verify professional credentials. Please complete Section 1 below and submit it, along with the required fee to:
NBRC Executive Office
18000 W. 105th Street
Olathe, KS
FEES (Based on active or inactive NBRC membership):
$5 fee for active members $20 fee for inactive members
SECTION 1:
_____ I am applying for state licensure in (STATE NAME __________________), and I am requesting
the NBRC to verify my credential(s) directly to the (STATE AGENCY
______________________________).
I hold the following NBRC credentials:
____ RRT____ CPFT |
____ |
____ CRT____ RPFT |
____ |
PRINT NAME UNDER WHICH YOU WERE CREDENTIALED:
_______________________________________________________________
Last |
First |
Middle Initial |
Former Name |
COMPLETE THE INFORMATION BELOW: |
|
||
_______ - _______ - ________
Social Security Number
_______________________________________________________________
LastFirst Middle Initial Former Name
_______________________________________________________________
Street /Apt. #
_______________________________________________________________
CityState Zip Code
_______________________________________________________________
Business PhoneHome Phone
_______________________________________________________________
Signature |
Date |
RCB 020 (4/07) This form supersedes all previous editions |
|
Document Properties
| Fact Name | Details |
|---|---|
| Form Title | Ohio RCB 020 is officially known as the NBRC Credential Verification Form. |
| Governing Body | This form is governed by the Ohio Respiratory Care Board. |
| Submission Address | Applicants must submit the form to the NBRC Executive Office in Olathe, Kansas. |
| Verification Fee | The fee for verifying credentials is $5 for active NBRC members and $20 for inactive members. |
| Purpose | The form is used to request verification of professional credentials for state licensure. |
| Required Information | Applicants need to provide personal information including name, social security number, and contact details. |
| Credential Types | Various NBRC credentials can be verified, including RRT, CPFT, CRT-NPS, CRT, RPFT, and RRT-NPS. |
| Signature Requirement | Applicants must sign and date the form to validate their request. |
| Edition Superseded | This edition of the form supersedes all previous versions. |
Documents used along the form
When applying for licensure in Ohio, several forms and documents accompany the Ohio RCB 020 form. Each of these documents plays a crucial role in ensuring that your application is complete and that your credentials are verified appropriately. Below is a list of commonly used forms that you may need to consider.
- Ohio Respiratory Care Licensure Application: This is the primary application form required to apply for licensure as a respiratory care professional in Ohio. It collects essential personal information, educational background, and professional experience.
- NBRC Credential Verification Form: Similar to the RCB 020, this form is specifically used to verify your credentials with the National Board for Respiratory Care. It is essential for confirming your qualifications.
- Background Check Authorization Form: This document allows the state to conduct a criminal background check as part of the licensure process. Completing this form is vital to ensure compliance with state regulations.
- Transcripts from Educational Institutions: Official transcripts from your respiratory care program are often required to demonstrate that you have completed the necessary education and training for licensure.
- Gift Certificate Form: This document allows individuals to redeem a specified value for goods or services at a designated merchant. For customizable options, visit smarttemplates.net.
- Proof of Continuing Education: If applicable, this document shows that you have completed the required continuing education units (CEUs) to maintain your credentials. It is essential for both initial licensure and renewal.
- Verification of Employment Form: This form may be needed to confirm your work history and experience in the field of respiratory care. It helps to validate your practical skills and knowledge.
- Application Fee Payment Receipt: A copy of your payment receipt for the application fee is necessary. This receipt serves as proof that you have paid the required fees for processing your application.
Each of these forms contributes to a thorough review of your qualifications and ensures that the licensing process proceeds smoothly. It’s important to gather all necessary documents to avoid delays in your application. Being organized and prepared will help you navigate the process with confidence.
Guidelines on Filling in Ohio Rcb 020
Completing the Ohio RCB 020 form is an essential step in the credential verification process. This form must be filled out accurately to ensure that your professional credentials are verified by the National Board for Respiratory Care (NBRC). Follow these steps carefully to complete the form.
- Begin by downloading or obtaining a copy of the Ohio RCB 020 form.
- In Section 1, write the state name where you are applying for licensure.
- Indicate the state agency to which the NBRC should send your credential verification.
- Check the box next to the NBRC credentials you hold: RRT, CPFT, CRT-NPS, CRT, RPFT, or RRT-NPS.
- Print your name as it appears on your credentials in the designated area.
- Fill out your Social Security Number in the provided format: XXX-XX-XXXX.
- Complete your address, including street, apartment number (if applicable), city, state, and zip code.
- Provide your business and home phone numbers.
- Sign and date the form at the bottom.
- Determine the appropriate fee based on your NBRC membership status: $5 for active members or $20 for inactive members.
- Submit the completed form along with the required fee to the NBRC Executive Office at the specified address.
Common mistakes
When filling out the Ohio RCB 020 form, one common mistake is neglecting to provide the correct state name where you are applying for licensure. This section is crucial, as it ensures that your credentials are sent to the appropriate state agency. Without this information, the verification process may be delayed or even halted.
Another frequent error involves the Social Security Number section. Applicants sometimes enter their number incorrectly, which can lead to significant issues. A simple typo can cause problems in verifying your identity and credentials. Make sure to double-check the numbers you provide to avoid unnecessary complications.
Many individuals also forget to include their signature and date at the bottom of the form. This step is essential for validating your application. Without a signature, the form may be considered incomplete, leading to further delays in processing your request.
Finally, applicants often overlook the required fee based on their NBRC membership status. It is important to include the correct payment amount to avoid delays in processing. Remember, active members pay $5, while inactive members owe $20. Failing to include the correct fee can result in your application being returned.
FAQ
-
What is the Ohio RCB 020 form?
The Ohio RCB 020 form is a credential verification form required by the Ohio Respiratory Care Board. It is used to verify professional credentials for individuals applying for state licensure in respiratory care.
-
Who needs to complete the Ohio RCB 020 form?
Individuals applying for state licensure in Ohio and who hold credentials from the National Board for Respiratory Care (NBRC) must complete this form. This includes those with active or inactive NBRC memberships.
-
What information do I need to provide on the form?
You will need to provide your personal information, including your name, Social Security number, contact details, and the specific NBRC credentials you hold. Additionally, you must indicate the state agency to which you want your credentials verified.
-
What are the fees associated with the Ohio RCB 020 form?
There is a fee required for the verification of credentials. If you are an active NBRC member, the fee is $5. For inactive members, the fee is $20. Payment must be submitted along with the completed form.
-
Where do I send the completed form and payment?
After completing the form, send it along with the required fee to the NBRC Executive Office at:
18000 W. 105th Street
Olathe, KS 66061-7543 -
What credentials can I request verification for?
You can request verification for several NBRC credentials, including:
- RRT (Registered Respiratory Therapist)
- CPFT (Certified Pulmonary Function Technologist)
- CRT-NPS (Certified Respiratory Therapist - Neonatal/Pediatric Specialist)
- CRT (Certified Respiratory Therapist)
- RPFT (Registered Pulmonary Function Technologist)
- RRT-NPS (Registered Respiratory Therapist - Neonatal/Pediatric Specialist)
-
Do I need to provide my Social Security number?
Yes, you must include your Social Security number on the form. This information is necessary for the verification process.
-
What if I have a former name?
If you have a former name, you should provide that information on the form. This helps ensure accurate verification of your credentials.
-
How can I contact the Ohio Respiratory Care Board if I have questions?
You can contact the Ohio Respiratory Care Board at the following phone number: 614.752.9218. They can assist you with any questions regarding the form or the licensure process.