WA Credential Status Change Form 2016 free printable template

DOH 505-089 February 2016 Page 1 of 3 Qualifications of Personnel for Moderate Complexity Testing Director check only one FF 1. Medical Test Site MTS Credentialing P. O. Box 47877 Olympia WA 98504-7877 360-236-4700 Credential Status Change Form Use this form for address phone number fax number email or facility name or contact changes to individual credentials. Send the completed change form to the address listed above. Complete pages two and three only if you are changing the director of a...

How to fill out WA Credential Status Change Form

How to fill out WA Credential Status Change Form

1. Obtain the WA Credential Status Change Form from the Washington State Department of Health website.
2. Read the form instructions carefully to understand the required information.
3. Fill in your personal details including name, address, and contact information.
4. Indicate your current credential status and the desired change in status.
5. Provide any necessary supporting documentation as specified in the instructions.
6. Review your form for accuracy and completeness.
7. Sign and date the form to certify that the information provided is true.
8. Submit the completed form to the appropriate office, either by mail or electronically, as instructed.

Who needs WA Credential Status Change Form?

1. Individuals seeking to change their credential status in Washington State.
2. Professionals who have recently changed their practice status.
3. Those who have experienced a change in employment affecting their credentials.
4. Anyone required to update their credentials due to new regulations or requirements.

People Also Ask about

How do I renew my CNA license in WA?

Submit a completed Renewal Application (CDPH 283C) (PDF) along with documentation (CDPH 283A) (PDF) showing your completion of forty-eight (48) hours of In-Service Training/Continuing Education Units (CEUs) within your two (2) year certification period.

How do I email a document to DSHS?

Compose your message and add any file attachments by clicking Add attachment button and browsing to the file. Click send to send the message securely to DSHS. If you wish to save an unsent message to be completed or sent later, you can save the message as a draft. New draft messages are saved to the Drafts folder.

How do I renew my CNA license online in Washington state?

Login to the Department of Health HSQA Online Services after logging into SAW. New users must create an account with SAW. Instructions for new users are available or you may start creating an account and renew online here. You'll need the service code 7472 to access the HSQA Online Renewal System.

Can I get a replacement EBT card the same day Washington State?

Did you lose your EBT Card, or need to report a stolen EBT card? Call Fidelity Information Services (FIS) at 1-888-328-9271. A replacement card will be mailed to you within 5-10 business days. You can also check your EBT account by going to the Fidelity Information Services EBT Account website.

Can I get a replacement EBT card the same day?

Replace an EBT Card If you make your request online or by phone, it will take from 7 to 10 business days for you to get your replacement card. Permanent replacement cards can only be mailed to the address on record. Please note that, as of January 15, 2020, EBT cards with photos are no longer issued.

What are verification documents for DSHS Washington State?

For example, if we needed proof of who you are, you could provide us a driver's license, a birth certificate, or a passport. Any of these items would prove to us who you are. Common things we need to verify are: Identity.

How do I contact my WA state representative?

If you wish to leave a message for your state Senator and Representatives, call the Legislative HOTLINE at 1.800. 562.6000.

Who do I call to get food stamps in Washington state?

How to Apply For Basic Food Benefits: You can apply for Basic Food Assistance online, by phone at 877-501-2233 or at your local Community Services Office.

What number do I call for food stamps in Washington state?

How to Apply For Basic Food Benefits: You can apply for Basic Food Assistance online, by phone at 877-501-2233 or at your local Community Services Office.

What is state of Washington secure email portal?

The State of Washington Secure Email Portal (Secure Email Portal) is a secure way to compose, receive, view, reply to and forward encrypted messages over the Internet. Messages are encrypted individually for each recipient and include a certified time stamp.

How do I contact Washington State?

1-800-833-6384.

How do I speak to someone at EBT Washington State?

Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service. Apply for benefits or submit documents. 9 a.m. to 4 p.m.: Pick up an EBT card in the office.

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What is WA Credential Status Change Form?

The WA Credential Status Change Form is a document used to notify the relevant authorities in Washington state about changes in the status of an individual's professional credential.

Who is required to file WA Credential Status Change Form?

Individuals who hold professional credentials in Washington state and experience a change in their credential status are required to file the WA Credential Status Change Form.

How to fill out WA Credential Status Change Form?

To fill out the WA Credential Status Change Form, individuals should provide their personal information, details about their credential, and the specific changes in status. Following the instructions provided on the form is essential to ensure accurate completion.

What is the purpose of WA Credential Status Change Form?

The purpose of the WA Credential Status Change Form is to formally communicate any changes in a professional's credential status to the relevant authorities, thereby maintaining accurate records and compliance with state regulations.

What information must be reported on WA Credential Status Change Form?

The information that must be reported on the WA Credential Status Change Form includes the individual's name, credential type, current status, the nature of the status change, and any relevant supporting documentation.