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Collects applicant identification, contact, and driver’s license/ID details, date of birth, and required declarations. Requires answers on convictions and adverse licensing actions, plus training/CEU hours and work experience within specified two-year periods. Includes instructions for CNA reactivation when renewal requirements were not met, and an applicant certification signature under California perjury laws. No processing fee is charged.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/state-of-california-health-and-human-services-agency-certified-nurse-assistant-cna-andor-home-health-aide-hha-renewal-application/306320/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/state-of-california-health-and-human-services-agency-certified-nurse-assistant-cna-andor-home-health-aide-hha-renewal-application/306320.png","ImageObject",442,249,{"name":88,"@type":89},"Aria Callaghan","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-25","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Is there a fee to process this CNA/HHA renewal application?","Question",{"text":109,"@type":110},"No fee is charged to process the application.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What happens if the applicant does not answer all applicable questions?",{"text":114,"@type":110},"The application will not be processed if all applicable questions are not answered.",{"name":116,"@type":107,"acceptedAnswer":117},"What certification declarations are required in Section VII?",{"text":118,"@type":110},"The applicant must certify under penalty of perjury that the information provided is true and correct, and sign and date the application.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306320,1789835385,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","State of California-Health and Human Services Agency MAIL OR FAX APPLICATION TO:  \nCERTIFIED NURSE ASSISTANT (CNA) AND/OR HOME HEALTH AIDE (HHA) RENEWAL APPLICATION  \n(See instructions on the reverse)  \nCalifornia Department of Public Health (CDPH) Licensing and Certification Program (L&C)  \nAide and Technician Certification Section (ATCS) MS 3301, P.O. Box 997416  \nSacramento, CA 95899-7416 PHONE: (916) 327-2445 FAX: (916) 552-8785  \nEMAIL: [cna@cdph.ca.gov](cna@cdph.ca.gov)  \nTHERE IS NO FEE TO PROCESS THIS APPLICATION. YOUR APPLICATION WILL NOT BE PROCESSED IF ALL APPLICABLE QUESTIONS ARE NOT ANSWERED.  \n\n| SECTION I (REQUIRED) |  |  |\n| --- | --- | --- |\n| TYPE OF REQUEST |  |  |\n|  CNA Renewal (complete sections I, II, III, V, and VII) | Certificate | number:  |\n|  HHA Renewal (complete sections I, II, III, IV, and VII) | Certificate | number:  |\n|  CNA Reactivation (complete sections I, II, III, V, VI, and VII) | Certificate | number:  |\n\nSECTION II (REQUIRED)  \n\n| Last Name |  | First Name | MI | Sex\u003Cbr> Male  Female |\n| --- | --- | --- | --- | --- |\n| Mailing Address (Number and Street or P.O. Box Number) |  | City | State | Zip Code |\n| Date of Birth | *Social Security Number (SSN)\u003Cbr>- -\u003Cbr>*If you use an invalid SSN, your application process may be delayed | Driver’s License or State ID Number\u003Cbr>Number:   State:   | Telephone Number |  |\n\nSECTION III (REQUIRED)  \n1) Subsequent to your last renewal, have you been CONVICTED, at any time, of any crime, other than a minor traffic violation? (You need not disclose any marijuana-related offenses specified in the marijuana reform  \nYes No  \nlegislation and codified at the Health and Safety Code, Sections 11361.5 and 11361.7) .  \n- If yes, list conviction:  Court of conviction:   \n2) Subsequent to your last renewal, has any health-related licensing, certification or disciplinary authority taken  \nadverse action (revoked, annulled, cancelled, suspended, etc. ) against you?  \n- If yes, indicate the type and number of license/certificate:   \nDate:   \nYes No  \n| SECTION IV (IF APPLICABLE) |  |\n| --- | --- |\n| HHA APPLICANTS ONLY:\u003Cbr>3) I have successfully completed and included documentation of twenty-four (24) hours of In-Service Training/\u003Cbr>Continuing Education Units (CEUs) during my most recent certification period. Twelve (12) of the twenty-four (24) hours were completed in each year of my two (2) year certification period (HHAs may not complete online CEUs) . | Yes No\u003Cbr>|\n| SECTION V (IF APPLICABLE) |  |\n\nCNA APPLICANTS ONLY: If you answered “No” to either question number 4 or 5, please go to question 6.  \n4) I have successfully completed and included documentation of forty-eight (48) hours of In-Service Training/ Yes No CEUs during my most recent certification period. Twelve (12) of the forty-eight (48) hours were completed in   each year of my two (2) year certification period (CNAs may complete a maximum of twenty-four (24) online CEUs) .  \n5) Have you worked as a CNA in a facility for compensation (under the supervision of a licensed health professional) Yes No within your two (2) year certification period? If you have, check the “Yes” box and provide the facility information   below, as well as list the dates of employment. If you have not, check the “No” box and you may continue to  \nSection VI.  \n\n| Facility Name | Telephone Number | Employment Dates |  |  |\n| --- | --- | --- | --- | --- |\n|  |  | From: |  | To: |\n| Mailing Address (Number and Street or P.O. Box Number) | City | State | Zip Code |  |\n\nSECTION VI (IF APPLICABLE)  \nCNA APPLICANTS WHO DID NOT MEET RENEWAL REQUIREMENTS ONLY:  \n6) REACTIVATION: I have not completed one (1) or both of the renewal requirements listed above in questions  \n4 and 5 and wish to reactivate my CNA certificate by taking the Competency Evaluation (see C on the reverse) . If approved, a Competency Evaluation approval letter will be sent to you, along with information to schedule the evaluation.  \nYes No  \nSECTION VII (REQUIRED) ","cbCain0wJvFlvSPA","https://ap.wps.com/l/cbCain0wJvFlvSPA","pdf",96721,"English","# SECTION I (REQUIRED)\n## TYPE OF REQUEST\n# SECTION II (REQUIRED)\n# SECTION III (REQUIRED)\n# SECTION IV (IF APPLICABLE)\n# SECTION V (IF APPLICABLE)\n# SECTION VI (IF APPLICABLE)\n# SECTION VII (REQUIRED)\n# RENEWAL INFORMATION","[{\"question\":\"Is there a fee to process this CNA/HHA renewal application?\",\"answer\":\"No fee is charged to process the application.\"},{\"question\":\"What happens if the applicant does not answer all applicable questions?\",\"answer\":\"The application will not be processed if all applicable questions are not answered.\"},{\"question\":\"What certification declarations are required in Section VII?\",\"answer\":\"The applicant must certify under penalty of perjury that the information provided is true and correct, and sign and date the application.\"}]","State of California - Health and Human Services Agency - Certified Nurse Assistant (CNA) and/or Home Health Aide (HHA) Renewal Application | PDF"]