Ariz. Admin. Code § R9-16-809 - Changes Affecting a Certificate; Request for a Duplicate Certificate

A. A certified CHW shall submit to the Department a notice in a Department-provided format within 30 calendar days after the effective date of a change in:

1. The certified CHW's home address, telephone number, or e-mail address, including the new home address, telephone number, or e-mail address; and

2. The certified CHW's name, including a copy of one of the following with the certified CHW's new name:

a. Marriage certificate,

b. Divorce decree, or

c. Other legal document establishing the certified CHW's new name.

B. A certificate holder may obtain a duplicate certificate by submitting to the Department a written request for a duplicate certificate in a Department-provided format that includes:

1. The certified CHW's name and address,

2. The certified CHW's certification number and expiration date,

3. The certified CHW's signature and date of signature, and

4. A duplicate certificate fee specified in R9-16-810.

Notes

Ariz. Admin. Code § R9-16-809

New section made by final rulemaking at 28 A.A.R. 2552, effective 11/7/2022.