331-030-0000 Application Requirements (1) An applicant who has been the subject of any adverse action, including the imposition of a civil or criminal penalty, is not qualified for an Oregon authorization to practice until the Office determines the scope and applicability of the disciplinary action as it relates to the applicant’s fitness to practice or use a professional title under an Office-administered program. The disciplinary record may include, but is not limited to, actions imposed from: (a) An Oregon health professional regulatory board as defined in ORS 676.160; (b) A regulatory authority in Oregon or another state; (c) A regulatory authority in another country or territory. (2) Pursuant to ORS 181A.195, and in accordance with OAR 125-007-0200 through 127-007-0330, the Office may determine an applicant’s fitness to practice in accordance with ORS 181A.195 and 670.280. (3) Material misrepresentation or material errors of fact on an application or renewal are grounds for disqualification of examination or discipline under ORS 676.612, or both. (4) Application or renewal for an authorization issued for any program administered by the Office shall be made on forms prescribed by the Office. (5) To be accepted and processed, an application must have the applicant’s: (a) Legal name, address and telephone number; (b) Date of birth; (c) Signature (d) Date of application; (e) Social Security or Individual Taxpayer Identification number as required by ORS 25.785, 305.385, 42 USC Sec. 405(c)(2)(C)(i), and 42 USC Sec. 666(a)(13). Failure to provide the Social Security or Individual Taxpayer Identification number will be a basis to refuse to accept the application or to issue an authorization. This information will be used for child-support enforcement and tax-administration purposes. (f) Disclosure of any active or inactive disciplinary action, voluntary resignation of a certificate, license, permit or registration or sanction related to authorization imposed upon the applicant by any state or country regulatory authority; (g) Disclosure of any active or inactive certificate, license, permit or registration issued by Oregon or another state; (h) Payment for the exact amount of required fees; and (i) All additional information required by the Office. (6) An applicant may be required to provide two forms of original identification issued by a federal, state or local government agency. The Office will consider other forms of identification if the procedures used in issuing the identification are sufficient to prove the applicant’s identity, and it contains security features that are sufficient to prevent alteration or counterfeiting. Acceptable identification includes, but is not limited to: (a) An original or certified copy of birth certificate. The Office will not accept a hospital-issued birth certificate, hospital card or birth registration or baptismal certificate. (b) A United States passport not expired more than five years. (c) A United States passport card not expired more than five years. (d) U.S. Territory passport not expired more than five years. (e) Tribal ID card from a federally recognized tribe. (f) Certificate of Citizenship (N560 and N561). (g) Certificate of Naturalization (N550, N570 and N578). (h) U.S. Citizen Identification Card (I-197 and I-179). (i) U.S. Military documents including: (A) Military or Armed Forces ID Card; (B) Military Common Access Card; or (C) U.S. Uniform Services ID and Privileges Card (DD1173 and DD1173-1). (j) N oncitizen resident card, such as a Green Card, or Permanent Resident Card (I-551). (k) Valid government-issued driver’s license, instruction permit or identification card that contains the applicant's photograph. (l) Concealed weapon permit or concealed handgun license, not expired more than one year. (m) United States-issued Social Security card, and any documentation required to authenticate the identity of the applicant. (n) Oregon medical-marijuana card. (7) The Office will not accept a document as proof of identity and date of birth if the Office has reason to believe the document is not valid. The Office may request an applicant present additional proof of identity. (8) At least one form of identification provided from the approved list in subsection (6) of this rule must be photographic. Statutory/Other Authority: ORS 25.785, ORS 181A.195, ORS 305.385, 42 USC § 405(C)(2)(C)(i), 42 USC § 666(a)(13), ORS 670.280, ORS 676.565, ORS 676.615, ORS 681.700-681.730 & Senate Bill 1560 (2022) Statutes/Other Implemented: ORS 25.785, ORS 181A.195, ORS 305.385, 42 USC § 405(C)(2)(C)(i), 42 USC § 666(a)(13), ORS 670.280, ORS 676.565, ORS 676.615, ORS 681.700-681.730 & Senate Bill 1560 (2022) History: HLO 7-2022, minor correction filed 04/26/2022, effective 04/26/2022 HLO 75-2018, minor correction filed 05/30/2018, effective 05/30/2018 HLO 71-2018, amend filed 04/30/2018, effective 05/01/2018 HLA 1-2009, f. & cert. ef. 6-1-09 Reverted to HLO 1-2004, f. & cert. ef. 2-13-04 HLA 12-2008(Temp), f. 11-28-08, cert. ef. 12-1-08 thru 4-30-09 HLO 1-2004, f. & cert. ef. 2-13-04