R9-16-809. Changes Affecting a Certificate; Request for a Duplicate Certificate

A. A certified CHW shall submit to the Department a notice in a Department-provided format within 30 calendar days after the effective date of a change in: 1. The certified CHW’s home address, telephone number, or e-mail address, including the new home address, telephone number, or e-mail address; and 2. The certified CHW’s name, including a copy of one of the following with the certified CHW’s new name: a. Marriage certificate, b. Divorce decree, or c. Other legal document establishing the certified CHW’s new name. B. A certificate holder may obtain a duplicate certificate by submitting to the Department a written request for a duplicate certificate in a Department-provided format that includes: 1. The certified CHW’s name and address, 2. The certified CHW’s certification number and expiration date, 3. The certified CHW’s signature and date of signature, and 4. A duplicate certificate fee specified in R9-16-810.