N.H. Code Admin. R. Opt 401.03 - Renewal Application

Current through Register Vol. 42, No. 14, April 7, 2022

(a) Before May 1 of each year in which a license is due to expire, the board shall mail to every optometrist licensed in the state a renewal application pursuant to RSA 327:13.

(b) The licensee shall file a renewal application form provided by the board and tender the renewal fee specified by Opt 303.01 Table 303.1 Fee Schedule.

(c) The licensee shall provide the following on or with the renewal application form:

(1) Name of the optometrist who is renewing;

(2) Office address(es) and phone number(s) of the optometrist who is renewing;

(3) A statement indicating whether the applicant is actively practicing optometry;

(4) Home address of the optometrist who is renewing;

(5) A statement that the information included in the applicant's initial application has not changed except to the extent it has been previously disclosed to the board or is disclosed and described in an attachment to the renewal application;

(6) Whether the applicant has been the subject of disciplinary action, or has been denied a license or surrendered a license in any state or jurisdiction during the past 12 months; and

(7) Signature of applicant and date signed.

Notes

N.H. Code Admin. R. Opt 401.03

(See Revision Note at part heading for Opt 100) #5839, eff 6-17-94, EXPIRED: 6-17-00

New. #7433, eff 1-25-01, EXPIRED: 1-25-09

New. #9558, eff 10-6-09

Amended by Volume XXXVII Number 41, Filed October 12, 2017, Proposed by #12383, Effective 9/16/2017, Expires 9/16/2027.