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Ohio Rcb 020 Form

The Ohio RCB 020 form is a credential verification document required by the National Board for Respiratory Care (NBRC) for individuals seeking state licensure in Ohio. Applicants must complete the form and submit it along with a fee, which varies based on their NBRC membership status. This process ensures that the professional credentials of respiratory care practitioners are properly verified before licensure is granted.

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The Ohio RCB 020 form is an essential document for individuals seeking licensure in the respiratory care field within Ohio. This form, issued by the Ohio Respiratory Care Board, facilitates the verification of professional credentials through the National Board for Respiratory Care (NBRC). Applicants must complete Section 1, where they indicate their intent to apply for state licensure and request the NBRC to verify their credentials directly to the appropriate state agency. The form requires specific information, including the applicant's name, Social Security number, and contact details. Additionally, applicants must pay a verification fee, which varies based on their NBRC membership status—$5 for active members and $20 for inactive members. The form also allows applicants to list their NBRC credentials, such as RRT, CRT, and CPFT, ensuring that all necessary information is submitted for a thorough verification process. Understanding the significance of the RCB 020 form is crucial for prospective respiratory care professionals as they navigate the licensure requirements in Ohio.

Form Sample

NBRC CREDENTIAL VERIFICATION FORM

OHIO RESPIRATORY CARE BOARD 77 S. High Street, 16th Floor Columbus, Ohio 43215-6108 614.752.9218 www.state.oh.us/rsp

TO APPLICANT:

The National Board for Respiratory Care, Inc. (NBRC) requires a fee to verify professional credentials. Please complete Section 1 below and submit it, along with the required fee to:

NBRC Executive Office

18000 W. 105th Street

Olathe, KS 66061-7543

FEES (Based on active or inactive NBRC membership):

$5 fee for active members $20 fee for inactive members

SECTION 1:

_____ I am applying for state licensure in (STATE NAME __________________), and I am requesting

the NBRC to verify my credential(s) directly to the (STATE AGENCY

______________________________).

I hold the following NBRC credentials:

____ RRT____ CPFT	____ CRT-NPS
____ CRT____ RPFT	____ RRT-NPS

PRINT NAME UNDER WHICH YOU WERE CREDENTIALED:

_______________________________________________________________

Last	First	Middle Initial	Former Name
COMPLETE THE INFORMATION BELOW:

_______ - _______ - ________

Social Security Number

_______________________________________________________________

LastFirst Middle Initial Former Name

_______________________________________________________________

Street /Apt. #

_______________________________________________________________

CityState Zip Code

_______________________________________________________________

Business PhoneHome Phone

_______________________________________________________________

Signature	Date
RCB 020 (4/07) This form supersedes all previous editions

⇩ PDF

Form Information

Fact Name	Details
Form Purpose	This form is used to verify professional credentials for applicants seeking state licensure in Ohio.
Governing Body	The Ohio Respiratory Care Board oversees the use of this form.
Fee Structure	Active NBRC members pay a $5 fee, while inactive members are charged $20.
Submission Address	Completed forms must be sent to the NBRC Executive Office in Olathe, Kansas.
Credential Types	Applicants can hold various NBRC credentials, including RRT, CPFT, CRT-NPS, CRT, RPFT, and RRT-NPS.
Social Security Requirement	Applicants must provide their Social Security Number on the form.
Contact Information	Applicants need to include both business and home phone numbers.
Signature Requirement	A signature and date are required from the applicant to validate the form.
Form Version	The current version of this form is RCB 020, dated 4/07, and it replaces all prior editions.

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