1. (a) The applicant for license renewal, or the duly-authorized individual for an applicant that is an entity, shall sign and date the application, provided that for applications that are submitted electronically, the act of submitting the application shall constitute the signature and the date of submittal shall be the date.

2. (b) The signature shall constitute the applicant’s attestation that:

   1. (1) The applicant is not under investigation by any professional licensing board and the applicant’s credentials have not been suspended or revoked by any professional licensing board, or a written explanation of each such occurrence is being submitted with the application pursuant to Plc 308.07(a);
   2. (2) If required by applicable law, the applicant has completed the survey or opt-out form provided by the office of rural health, department of health and human services;
   3. (3) The information and documentation provided are true, complete, and not misleading to the best of the applicant’s knowledge and belief;
   4. (4) The applicant understands that providing false or misleading information constitutes grounds for denial, suspension, or revocation of a license;
   5. (5) The applicant understands that providing false material information constitutes a misdemeanor under RSA 641:3 relative to falsification in official matters; and
   6. (6) The applicant understands that if the applicant fails to submit a complete application prior to the expiration of the applicant’s current license, the applicant’s license shall expire by operation of law, specifically RSA 310:8, III.

Source. (See Revision Note #1 at chapter heading for Plc 300) #13606, eff 5-1-23; ss by #13955, eff 5-3-24 (see Revision Note #2 at chapter heading for Plc 300); ss by #14305, eff 8-19-25, EXPIRES: 8-19-35