Mail or fax the completed form to the California Department of Public Health (CDPH), Licensing and Certification Program, Aide and Technician Certification Section, MS 3301, P.O. Box 997416, Sacramento, CA 95899-7416. Fax: (916) 552-8785. Email inquiries to: cna@cdph.ca.gov. Ensure all sections are filled out accurately and attach required documents for a smooth process. My advice is to double-check all entries for correctness and completeness before submission to avoid delays.

This form needs to be renewed every two years for CNAs and every four years for HHAs, based on the expiration date of your certificate. Ensure timely submission to avoid delinquency.

The purpose of this form is to facilitate the renewal or reactivation of certification for Certified Nurse Assistants (CNA) and Home Health Aides (HHA) in California. By maintaining updated certification, healthcare professionals ensure they meet state requirements, which allows them to continue providing quality care. It also helps in keeping the workforce legally compliant and assures employers of their employees' qualifications.

• 1. Type of Request: Indicates whether the application is for CNA renewal, HHA renewal, or CNA reactivation.
• 2. Personal Information: Includes fields for last name, first name, public and confidential addresses, social security number, email, date of birth, and phone number.
• 3. Convictions and Licensing Actions: Requires disclosure of any convictions or adverse actions taken against any health-related license or certification.
• 4. Training and Employment Verification: Covers verification of In-Service Training or Continuing Education Units (CEUs) and employment details for CNAs and HHAs.
• 5. Reactivation: For CNA applicants who did not meet renewal requirements and seek reactivation by taking the Competency Evaluation.
• 6. Certification: Requires applicant's signature, date, and declaration of truthfulness under penalty and perjury.

Failure to submit this form or provide accurate information could result in the lapse of your certification status. This impacts your legal ability to work as a CNA or HHA.

• Certification Lapse: Your certification will become invalid, and you will be placed on delinquent status.
• Employment Impact: You may not legally present yourself as a certified CNA or HHA, affecting job eligibility.

• 1. Certificate Renewal: When your current certificate is expiring and needs renewal.
• 2. Certificate Reactivation: If your certification has lapsed and you need to undergo reactivation processes.
• 3. Dual Certification: When holding dual CNA and HHA certification and renewing both simultaneously.
• 4. New Employment Verification: When starting a new job that requires verification of valid certification.
• 5. Compliance: To remain compliant with state health and safety regulations.