Fees
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Applications
These forms may be completed online, however, they cannot be submitted via e-mail due to the fact that all applications and forms require original signatures. If you complete the form online, you must print the form and mail it to the address below.
Fees (if applicable) are payable to the "Licensure Unit".
Licensure Unit
PO Box 94986
Lincoln, NE 68509-4986
Application for Individuals to Conduct Lead-Based Paint Activities
Duplicates/Reissue Form
Name Change Form
Reinstatement Application
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Renewal Information
- All lead-based paint licenses expire two years from the date of issuance.
- Individuals may renew their license any time up to one year after its expiration. After one year they need to reapply for initial licensure.
- To renew a license, the licensee holder must submit to the Department of Health and Human Services, Licensure Unit:
- the Renewal Notice;
- applicable renewal fee;
- documentation of successful completion within the preceding year of a lead-based paint refresher training course (within the discipline applied for) approved by the Department of Health and Human Services, Lead-Based Paint Program with proof of passing the end of refresher course training examination;
- a completed physical examination form showing that they have been examined by a physician, within the preceding 12 months, and declared to be physically capable of working while wearing a respirator. Only workers and supervisors are required to obtain a physical examination;
- A renewal notice will be sent out to the last address of record at least 30 days prior to expiration.
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Continuing Education
As a condition of renewal of the license, and before submitting the renewal notice to the Department of Health and Human Services, Licensure Unit, the applicant must successfully complete an approved refresher course or approved initial program if applicable for the profession they are applying.
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Name and Address Change
To request an address change, you can contact Patti Owens at (402) 471-2299 or e-mail patricia.owens@nebraska.gov
If you wish to change your name on your license record, you must complete the
Affidavit of Name Change form and submit it with a copy of the legal document verifying name change to:
Licensure Unit
Lead Based Paint Credentials
PO Box 94986
Lincoln, NE 68509-4986
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Certifications/Verifications
Certification and Verification information can be obtained by checking the website at: www.dhhs.ne.gov/publichealth/Pages/lis_lisindex.aspx
OR
To request either a certification or verification or your license to be sent to another state licensing agency, send your request in writing along with the proper fee to the our office. Checks should be made payable to the Licensure Unit.
Certification
- Fee - $25.00
- Certification includes:
- Name
- Profession
- License number
- Issuance date
- Expiration date
- Whether the license was granted by examination, waiver, or reciprocity
- Examination information, if available
- Whether disciplinary action has been taken against the license. If so, the type(s) and date(s) of the action will be included.
- SEAL of the Nebraska Department of Health & Human Services
Verification
- Fee - $5.00
- Verification includes:
- Name
- Profession
- License Number
- Expiration Date
- Department Staff Signature
A verification does not include the SEAL of the Nebraska Department of Health & Human Services nor information relating to discipline, or examination.
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Duplicates/Reissue
Duplicates: A duplicate large license or small license card may be requested at the time of initial licensure.
Reissue: A large license and/or small license card may be reissued when the licensee requests: additional documents; replacement of original document(s) due to loss, mutilation or destruction; or replacement of document(s) due to a name change.
To request a reissued license, you must submit a
request for reissuance. Submit said request to:
Licensure Unit
Lead Based Paint Credentials
PO Box 94986
Lincoln NE 68509-4986
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Rules and Regulations/Statutes
Lead-Based Paint Activities Regulations - 178 NAC 23
Statutes Relating to Lead-Based Paint Activities
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Contact Us
Office Address: