Section Psyc 401.02 - License Renewal(a) A license to practice psychology shall be renewed for 2 years upon approval by the board of a complete application submitted prior to the date of license expiration.(b) Any licensee wishing to renew an existing license shall submit a "Renewal Application Form" provided by the board with the following:(1) Name and license number;(2) Residence address and telephone number(s);(3) Business address and telephone number(s); (4) The name of an employer, if any;(5) An e-mail address, if any;(6) A statement indicating whether the applicant is actively engaged in the practice of psychology in New Hampshire;(7) Disclosure, and explanation where applicable, of the following information regarding the previous 2-year period: a. Whether any malpractice claim has been made against the applicant, regardless of whether a lawsuit was filed in relation to the claim;b. If the applicant has any complaints pending against a license or certificate in any state or jurisdiction, excluding NH;c. If the applicant has been found civilly liable for professional misconduct or committing an ethical violation, or has entered into a settlement agreement to resolve a misconduct or ethical complaint with any state or provincial regulatory authority or board outside of NH since the last renewal of the NH license; d. If the applicant has voluntarily surrendered a license to practice psychology in lieu of disciplinary action;e. If the applicant has been convicted of a felony or misdemeanor;f. If the applicant knows of any reason why he or she might be unable to practice psychology in a competent and ethical manner;g. If the applicant has a plan in place to manage his or her clinical records in the event of death or incapacity; andh. Whether the applicant is actively practicing a mental health discipline regulated by the board;(8) On the board provided "Attestation to CEU's and Collaboration" form, the applicant's notarized dated signature, license number, and printed name, which shall verify that the applicant is in compliance with the continuing education requirements of Psyc 402.01 and the interdisciplinary collaboration activities required pursuant to Psyc 403;(9) The applicant' signature which acknowledges: a. That the provision of false information in the application is a basis for disciplinary action by the board; andb. That the information and documentation provided in the application is true, accurate, complete, and unaltered; and(10) The date the applicant signed the application.(c) The filing fee shall be as established by RSA 310-A:1-e (a), I.(d) Pursuant to RSA 126-A:5, XVIII-a(a) and RSA 329-B:10-a, licensees shall complete, as part of their renewal application, the applicable New Hampshire division of public health service's health professions survey issued by the state office of rural health and primary care, department of health and human services, pursuant to He-C 801.(f) Licensees choosing to opt-out of the survey shall complete and submit the "New Hampshire Health Professions Survey Opt-Out Form," effective April 2019, to the state office of rural health and primary care, department of health and human services, via one of the following:(g) Information contained in the opt-out forms shall be kept confidential in the same accord with the survey form results, pursuant to RSA 126-A:5XVIII-a.(c).N.H. Admin. Code § Psyc 401.02
Derived From Volume XXXVI Number 49, Filed December 8, 2016, Proposed by 12035-B, Effective 11/4/2016, Expires 11/4/2026.Amended by Volume XXXIX Number 24, Filed June 13, 2019, Proposed by #12779, Effective 5/14/2019, Expires 5/14/2029.