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The form also records required continuing education hours across Category I, II, III, and IV with course tables and 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Last Name   |  | First Name   |  |\n| --- | --- | --- | --- |\n| Address   |  | City,State,Zip Code   |  |\n| Home Phone   |  | Work Phone   |  |\n| Cell Phone   |  | Email   |  |\n\n\n| ACRN Information   |  | RN Information   |  |\n| --- | --- | --- | --- |\n| Year of Initial  \u003Cbr>Certification   |  | State of Licensure   |  |\n| Year of Last  \u003Cbr>Recertification   |  | RN License Number   |  |\n| AACRN Certificate  \u003Cbr>Number   |  | RN License Expiration  \u003Cbr>Date   |  |\n\nSubmit this form and pay online via the HANCB website.  \nOr mail completed form with appropriate fee to:  \nHANCB Recertification11230 Cleveland Ave NW\\#986Uniontown,OH 44685  \nRecertification Fee,ANAC/CANAC Member:$300  \nRecertification Fee,Non-ANAC/CANAC Member:$400  \nLate Fee:$50 (due on applications submitted after certificate expiration date)  \n## A.Percent of Time Currently Working in HIV Nursing\n\nO Less than 25%  \n○ 25-50%  \nO 51-75%  \nO More than 75%  \n## B.Primary Position(Select only one response)\n\nO Clinical Nurse SpecialistO ConsultantO Counselor  \nO Director/Assistant DirectorO Head Nurse/Nurse ManagerInfection Control PractitionerNurse Case Manager/CoordinatorNurse Educator/Faculty MemberNurse PractitionerNurse ResearcherPatient Educator  \nSales/Marketing/Industry:Nursing RepStaff nurse/clinicianOther-please specify  \n## C.Area of Professional HIV Emphasis\n\nO AdultO PediatricsO Both adult and pediatrics  \nBackground InformationPlease complete the following information:  \n## D.Current Practice Setting(Select only one response)\n\nO Clinical Trial Group  \nO Community-Based OrganizationO Family Planning/STDO Forensic Setting(jail,prison)O HIV Testing CenterO Home CareO Hospice  \nO Inpatient:community hospital○ Inpatient:university affiliated hospitalO Long-term Care Facility○ Outpatient/ambulatory careO Physician's office○ Primary Prevention ProgramO Private/Group PracticeO Public/community health○ School of Nursing  \n○ Substance Abuse Treatment CenterO Other-please specify  \n## E.Experience in HIV Nursing\n\nO 3-6 years  \nO 7-10 years  \nO More than 10 years  \n## F.Employment Status\n\nO Full-time  \nO Part-time  \nO Unemployed  \nO Retired  \n## G.Primary Practice Location\n\nO Mixed  \nO Rural  \nO Suburban  \nO Urban (less than 1 million population)  \nUrban(more than 1 million population)  \nO Not applicable  \n## H.Highest Academic Level Earned\n\nO Doctorate in Nursing  \nO Doctorate,Other  \nO Masters,Nursing  \nO Masters,Other  \nO Other  \n## I.Other Certifications Held (ALL that apply)\n\nNone  \nO AAHIVS (AAHIVM)○ ACRN  \nO APRN(state nursing board)OBC(ANCC)CENCIC  \nCNS(state nursing board)CRNHONP-C(AANP)OCN○ Other  \n## J.Are you currently a member of ANAC/CANAC?\n\nO No  \nO Yes  \nIf yes,please provide your membership number  \n## Optional Information:\n\nRace/Ethnicity  \nO African American/Black○ Asian/Pacific IslanderO Hispanic/Latino/LatinaO Native AmericanO WhiteO Other  \nAge Range:  \nO Under 25  \n○ 25-29  \n○ 30-39  \nO 40-49  \nO 50-59  \nO 60 or older  \nGender:  \nO Female  \n○ Male  \nO Transgender  \nO Non-binary  \n○ Prefer not to answer  \n## Declaration\n\nI affirm that all statements given on this application are true and correct,to the best of myknowledge,and that HANCB is hereby authorized to contact any organization or individual listedhereon to verify my continuing education or licensure history  \nSignature of AACRN                                                                  \nDate                                                 \n## CREDIT CARD PAYMENT\n\nIf you want to charge your recertification fee on your credit card,please provide the following information:  \nName(as it appears on the card)  \nBilling Address(as it appears on the statement)  \nCharge my credit card for the total fee of $                    \nCard Type:  \no American Express  \no MasterCard  \no VISA  \nExpiration Date(month/year):    /    \nCVV\\#                                                                \nCard Number                                             ","cbCaibHhrEAePQNr","https://ap.wps.com/l/cbCaibHhrEAePQNr","pdf",1055194,"English","# ACRN Recertification Application Form\n## Payment and submission information\n## A. Percent of Time Currently Working in HIV Nursing\n## B. Primary Position (Select only one response)\n## C. Area of Professional HIV Emphasis\n## D. Current Practice Setting (Select only one response)\n## E. Experience in HIV Nursing\n## F. Employment Status\n## G. Primary Practice Location\n## H. Highest Academic Level Earned\n## I. Other Certifications Held (ALL that apply)\n## J. Are you currently a member of ANAC/CANAC?\n## Optional Information\n## Declaration\n## CREDIT CARD PAYMENT\n## Category I - HIV Nursing Continuing Education\n## Category II - Other Nursing Continuing Education\n## Category III - Academic Courses\n## Category IV - Professional Activities","[{\"question\":\"How are AACRN recertification submissions and payment completed?\",\"answer\":\"Submit the form and pay online via the HANCB website, or mail the completed form with the appropriate fee to the HANCB recertification address shown on the form.\"},{\"question\":\"What information is required about RN licensure and certification?\",\"answer\":\"Provide the year of initial certification and year of last recertification, the state of licensure, AACRN certificate number, RN license number, and RN license expiration date.\"},{\"question\":\"What are the continuing education hour limits by category?\",\"answer\":\"Category I requires 45 hours minimum; Category II allows up to 18 hours; Category III allows up to 35 hours; Category IV allows up to 20 hours, with course or activity details recorded in the tables.\"}]","AACRN Recertification Application Form | PDF",1789976916,48]