PURPOSE: This rule outlines the requirements and procedures for obtaining a hearing aid dealer and fitter

\ license by examination.

1. (1) Applications for a Missouri hearing aid dealer’s and fitter’s license must be made on forms provided by the department.
2. (2) Application forms may be obtained by writing the Council for Hearing Aid Dealers and Fitters at P.3. Box 1335, Jefferson City, MO 65102.1335. A copy of the current statutory provisions and departmental rules governing the fitting and sale of hearing aids will be provided with the application form.
3. (3) The department will not consider any application for examination unless it is fully completed and properly attested.
4. (4) Applications must be received by the department through the office no later than thirty (30) days prior to the examination. Applications received or completed less than thirty (30) days before the next examination scheduled will not be considered for that examination, but will be considered for the following examination.
5. (5) The examination will be administered in two (2) general parts, one (1) written and one
6. (1) practical. The examination will be scheduled every six (6) months.
7. (6) The written examination will be administered by the department through the council utilizing a national testing service or nationaltype examination wherever that examination and the required funds are available.

8. (7) The practical examination will be administered before or after the written examination, The practical examination will be conducted by the department through the council members or their designees and the following procedures and requirements shall apply:

   1. (A) It shall be the responsibility of the applicant to furnish all equipment needed to conduct a hearing test covering the techniques listed in section 346.085(2), RSMo. Equipment shall include an audiometer with speech testing capabilities, an otoscope, blank audiograms, ear mold impression material, appropriate word lists for determination of speech 4 CSR 160-2

threshold and speech discrimination ability if needed, and other related supplies; (B) Failure to bring the necessary equipment as listed in subsection (7)(A) will be sufficient reason to disallow the applicant the opportunity to take the practical examination and cause forfeiture of the examination fee. If the applicant wishes to take the next scheduled practical examination, s/he must reapply and pay the proper examination fee; and (C) The practical examination may be conducted at the discretion of the office using either simulators or live subjects for all or part of the examination, except that all persons taking the examination on a specific date shall be tested in the same manner. A time limit may be imposed for any part of the practical examination; provided, that a) this time limit is established by the office prior to the examination, b) that the time limit is reason able and c) that it is applied uniformly. (8) Requirements for Passing Grade. (A) For a license to be issued by the department, the applicant shall have achieved a general average of-

1. 1. Seventy-five percent (75%) on the written examination; and
2. 2. Seventy percent (70%) and no grade below sixty percent (60%) in any one (I) section of the practical examination.

1. (B) If the applicant fails the written examination, s/he may retake the entire written examination upon the payment of the proper reexamination fee.
2. (C) If the applicant fails one (1) or more portions of the practical examination, s/he may retake the entire practical examination upon the payment of the proper reexamination fee.

3. (D) When an applicant has successfully passed the written and practical portions of a scheduled examination, the scores of that examination shall be valid for a period of ninety (90) days (from the date of notification of a passing score) toward licensure. Auth: section 346.115(2) and (8), RSMo (1986).” Original rule filed Dec. 19, 1975, effective Dec. 29, 1975. Refiled Jan. 2, 1976. Rescinded and readopted: Filed Feb. 9, 1982, effective May 13, 1982. Amended: Filed March 1, 1984, effective July 12, 1984. Amended: Filed Feb. 15, 1989, effective April 27, 1989. Amended: Filed May 17, 1989, effective July 27, 1989. Amended: Filed Aug. 3, 1992, effective April 8,1993. *Original authority 1973, amended 1981.

   CODEOFSTATE REGULATIONS

   4CSR160-2-ECONOMIC DEVELOPMENT

   STATE OF MISSOURI COUNCIL APPLICATION FOR LICENSE

ALL QUESTIONS INDICATE N/A. RETURN COMPLETED

4PPLICATION 7 RECIPROCITY

WPLICANT NAME (LAST. FIRST. Ml)

4OME ADDRESS

“0L”NTP.W USED FOR IDENTlFlCATiON ONLY :OMPANY NAME AND ADDRESS :OMPANY NAME

HIGH SCHOOL

COLLEGE OR UNIVERSITY

dATIONAL HEARING AID SOCIETY :ERTIFICATION

,,AKE OF INSTRUMENTS FOR HEARING AID DEALERS AND FITTERS

MUST BE ANSWERED:

APPLICATION

COUNCIL FOR HEARING AID DEALERS&FITTERS P.O. BOX 1335 JEFFERSON CITY, MISSOURI IS FOR ($125) 0 LICENSE BY EXAMINATION ($751

WHERE LICENSE(S) WILL BE DISPLAYED

j DID YOU GRADUATE? (SUBMIT COPY) 0 YES YEAR b 17 NO CERTIFICATE OF EQUIVALENCY? 0 YES (SUBMIT COPY) CHECK YEARS COMPLETED

I

0 YES 0 NO

YOU WILL HANDLE IF NOT APPLICABLE,

ALONG WITH APPROPRIATE

65102

COMPLETE b

0 NO

b COLLEGEOR UNIVERSITY NAME

DATE

b

CODE OF STATE REGUtATlONS FEE TO:

HEAD&SHOULDERS

0 TEMPORARY PERMIT ($50)

/

01 02 03 04 05 OS DEGREE(S)

CERTIFICATION CURRENT? 0 YES 0 NO

I

(Z/16/93)

ATTACH PHOTO HERE

2’ x 2”

ONLY

YEAR OBTAINEC

lnYES[7NO / 0 YES I7 NO

Judith K. Moriarty semtary 0‘ state IMPORTANT: SEPARATE SHEET AND SIGNED BY YOU BEFORE A NOTARY PUBLIC AND NOTARIZED. 1. Have you previously If yes, WHEN If granted, give: NUMBER

2 Have you previously If Incensed, give: NUMBER

3 A. Have you ever applied for licensure If yes, WHERE

B If yes, were you ever If no, explain

1. C. How was your

D If you were If no, explain

1. E. Is your If no, explain
2. F. Has your If yes, explain

1. 4. Have you ever been convicted, contendere If yes, explain

5 Have you ever been addicted If yes, explain

1. 6. Have you ever been convicted, contendere If yes, explain
2. 7. Have you ever had a judgment deception other license If yes, explain

IST ALL EMPLOYMENT FOR THE PAST 5 YEA% (LIST PRESENT OR LAST POSITION FIRST) EMPLOYER NAME

Judith K. Moriarty EXPLANATIONS

applied

applied

as a hearing aid dealer

ltcensed by that state?

fully:

license obtained

licensed by that state, are you now fully.

license I” that state current? fully

license ever been disciplined fully:

to any crime (excluding fully:

fully.

to any traffic offense fully:

or malpractice related in the state of Missouri? fully: REQUIRED IN RESPONSE TO THE FOLLOWING QUESTIONS MUST BE ON A

for a temporary permit in MISSOURI?

SPONSOR

for a hearing a!d dealer or fitter license in MISSOURI? EXPIRATION DATE

for hcensure as a hearing aid dealer or taken the examination in any other state? _. WHEN

._.

(i.e., exam, reciprocity, other)

licensed by that state? _.

(i e., not lapsed or inactive) ._. ._, ._.

by that state? ._. .___. ._. _.

adjudged guilty by a court, pleaded guilty or pleaded nolo traffic violations)? ._. ._. ._. ,,

to any drug or alcohol? .___. ._. .___ ._. -

adjudged guilty by a court. pleaded guilty or pleaded nolo resulting from or related to the use of drugs or alcohol?.

rendered agatnst you based upon fraud, misrepresentation, to your practice as a hearing aId dealer or against any .__. ., ._

EMPLOYER ADDRESS

4CSR 160-2

0 YES 0 NO

0 YES 0 NO

0 YES [? NO

0 YES 0 NO

[7 YES 0 NO

0 YES 0 NO

[? YES 0 NO

fl YES 0 NO

0 YES 0 NO

0 YES 0 NO

0 YES q NO

DATES EMPLOYED

I do hereby affirm

and belief and understand

disqualification.

346.105 RSMo,

dishonorable conduct within

investigation of my present and past employment

for licensing.

KUST BE SIGNED 3TIRYPUBL,CiM805SERSEni

(REQLJRED ONLY OF APPLICANTS 4 CSR 160-2.030)

I do hereby affirm

the above excerpt and that

I further affirm my knowledge

dUST BE SIGNED that all statements made

that any deliberate

I further affirm that I have

(Supp.) especially Section

the meaning

IN PRESENCE OF NOTARY b

STATE OF MISSOURI

SUBSCRleEo AND SWORN BEFORE ME. THIS

NOTARY PUBLICSIGNATURE

FOR A TEMPORARY

that I am the holder of a currently

I fully understand my responsibilities

that I have read the application the answers to all questions

IN PRESENCE OF NOTARY b

SUBSCRlBED AND SWORN BEFORE ME, THIS

NOTARY PUBLlC SIGNATURE

in this application

falsrfication

read, understand

2 concerning specifications

of this section. Further,

and other activities

SiGNATURE OF APPLICANT

DAY OF

valid

under the provisions

of which

are true and complete. SIGNATURE OF SPONSOR

DAY OF are true and correct

of information

and agree

that may be deemed unprofessional

I hereby

for the purpose of verifying my qualifications

MY COMMlSSlON EXPIRES

PERMIT. SEE CHAPTER 346.075 RSMo,

license under

as sponsor

of the above cited Section of the law.

this affidavit will be a part and

MYCOMMlSSiON EXPlRES to the best of my knowledge

herein may constitute grounds

to abide by the provisions

voluntarily consent

COUNTY (OR CITY OF ST LcJ”lS)

USERUBBERSTAMPINCLEARAREABELOW

the laws of Missouri, that

for the applicant (NAME)

that

LICENSE NO

USE RUBBER STAMP IN CLEAR AREA BELO\n

(Z/16/93)

for my

of Chapter

or

to a thorough

(SUPP.) AND

I have read

to the best of

Judith K. Moriarty 4CSR160-2

SPONSOR RESPONSIBILITY

The responsibilities of the sponsor of a temporary permit holder in the state of Missouri are as follows: