Section Plc 306.04 - Information Required for Temporary License Application The applicant for a temporary license under this part shall provide the following information:
(a) The date the application for initial licensure was filed or is anticipated to be filed and the profession for which the application is being filed;(b) The applicant's full legal name including any suffix such as "Jr." or "III", and any other name(s) under which the applicant holds or has held a professional license;(c) The applicant's date of birth by month, day, and year;(d) The applicant's social security number as required by RSA 161-B:11, VI-a and 42 U.S.C. 666(a)(13);(e) The applicant's home physical address by street name and number, apartment number if applicable, municipality, county, state, zip code, and country if not the U.S., and home mailing address if different;(f) The applicant's home or other personal telephone number;(g) The applicant's designated e-mail address;(h) Whether the applicant is on active military duty or is the spouse of an individual on active military duty;(i) A list of each jurisdiction in which the applicant holds or has held a license to practice the occupation or profession for which a temporary license is sought and for each: (1) The license number and date of most recent licensure; and(2) The status of the license, such as active, expired, suspended, revoked, or denied renewal; and(j) Whether the applicant consents to the disclosure to third parties of any or all of the applicant's contact information.N.H. Admin. Code § Plc 306.04
Derived from Number 15, Filed April 13, 2023, Proposed by #13606, Effective 5/1/2023, Expires 5/1/2033.