Hearing Instrument Specialist

The practice of fitting hearing instruments shall mean the measurement of human hearing by means of an audiometer or by other means approved by the board solely for the purpose of making selections, adaptations, or sale of hearing instruments. The term also includes the making of impressions for earmolds. A dispenser, at the request of a physician or a member of related professions, may make audiograms for the professional’s use in consultation with the hard-of-hearing.

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Requirements for Licensure

To qualify for licensure as a Hearing Instrument Specialist based on examination you must submit:

1. A completed application;
2. Licensure fee
3. An official transcript (official means issued and sealed by the issuing institution) showing completion of a four-year course of study from an accredited high school; or An official copy (official means issued and sealed by the issuing institution) of a diploma or certificate from an accredited high school or its equivalent;
4. Official documentation of passing the International Hearing Society’s (IHS) examination for Hearing Instrument Specialist administered by the Department and the Nebraska Practical examination with the following scores:

• The passing score for the written comprehensive examination (National) is determined by using the Modified Nedelsky Method; and
• The practical examination passing scores shall be at least 70% in each subject examined, with an overall average of 70% or above.

5. Age:  Evidence of at least 21 years of age (i.e.:  driver’s license, birth certificate, marriage license, school transcript, US State ID card, Military ID, or similar documentation);
6. If you hold or have held a credential to provide health services, health related services, or hearing aid services in Nebraska, or in another jurisdiction, you must have the licensing agency submit to the Department a certification of your credential;
7. If you have had any disciplinary actions taken against your credential, you must submit a copy of the disciplinary action(s), including charges and disposition;
8. Conviction Information:  If you have been convicted of a felony or misdemeanor, you must submit:

• A copy of the court record, which includes charges and disposition;
• Explanation from the applicant of the events leading to the conviction (what, when, where, why) and a summary of actions you have taken to address the behaviors/actions related to the convictions;
• All addiction/mental health evaluations and proof of treatment, if the conviction involved a drug and/or alcohol related offense and if treatment was obtained and/or required; and
• A letter from the probation officer addressing probationary conditions and current status, if you are currently on probation;

9. Citizenship, lawful permanent residence, and/or immigration status Information:  You must submit a copy of at least one of the following documents:

1. A U.S. Passport (unexpired or expired);

2. A birth certificate issued by a state, county, municipal authority or outlying possession of the United States bearing an official seal;

3. An American Indian Card (I-872);

4. A Certificate of Naturalization (N-550 or N-570);

5. A Certificate of Citizenship (N-560 or N-561);

6. Certification of Report of Birth (DS-1350);

7. A Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240);

8. Certification of Birth Abroad (FS-545 or DS-1350);

9. A United States Citizen Identification Card (I-197 or I-179);

10. A Northern Mariana Card (I-873);

11. An Alien Registration Receipt Card (Form I-551, otherwise known as a “Green Card”);

12. An unexpired foreign passport with an unexpired Temporary I-551 stamp bearing the same name as the passport;

13. A document showing an Alien Registration Number (“A#”) with visa status; or

14. A Form I-94 (Arrival-Departure Record) with visa status;

To qualify for licensure as a Hearing Instrument Specialist based on a license issued in another jurisdiction, you must submit the following:

1. A completed application;
2. Licensure fee
3. Age:  Evidence of at least 21 years of age (i.e.:  driver’s license, birth certificate, marriage license, school transcript, US State ID card, Military ID, or similar documentation);
4. If you hold or have held a credential to provide health services, health related services, or hearing aid services in Nebraska or in another jurisdiction, you must have the licensing agency submit to the Department a certification of your credential;
5. If you have had any disciplinary actions taken against your credential, you must submit a copy of the disciplinary action(s), including charges and disposition;
6. Conviction Information:  If you have been convicted of a felony or misdemeanor, you must submit:

 

1. A copy of the court record, which includes charges and disposition;

2. Explanation from the applicant of the events leading to the conviction (what, when, where, why) and a summary of actions you have taken to address the behaviors/actions related to the convictions;

3. All addiction/mental health evaluations and proof of treatment, if the conviction involved a drug and/or alcohol related offense and if treatment was obtained and/or required; and

4. A letter from the probation officer addressing probationary conditions and current status, if you are currently on probation;

7. An official transcript (official means issued and sealed by the issuing institution) showing completion of a four-year course of study from an accredited high school; or an official copy of a diploma or certificate from an accredited high school or its equivalent.

8. Official documentation of passing an examination which consists of a written and practical examination. These exams need to be equivalent to the exams given by Nebraska

9. Citizenship, lawful permanent residence, and/or immigration status Information:  You must submit a copy of at least one of the following documents:

   1. A U.S. Passport (unexpired or expired);

   2. A birth certificate issued by a state, county, municipal authority or outlying possession of the United States bearing an official seal;

   3. An American Indian Card (I-872);

   4. A Certificate of Naturalization (N-550 or N-570);

   5. A Certificate of Citizenship (N-560 or N-561);

   6. Certification of Report of Birth (DS-1350);

   7. A Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240);

   8. Certification of Birth Abroad (FS-545 or DS-1350);

   9. A United States Citizen Identification Card (I-197 or I-179);

   10. A Northern Mariana Card (I-873);

   11. An Alien Registration Receipt Card (Form I-551, otherwise known as a “Green Card”);

   12. An unexpired foreign passport with an unexpired Temporary I-551 stamp bearing the same name as the passport;

   13. A document showing an Alien Registration Number (“A#”) with visa status; or

   14. A Form I-94 (Arrival-Departure Record) with visa status;

   Temporary Hearing Instrument Specialists

A temporary license may be issued to an applicant that has met all requirements for licensure except passing the licensure examination.  All temporary licenses will become null and void upon the Departments notification that the temporary license has passed the examination or a year from the issuance date, whichever comes first.  The temporary license may be renewed once for a 12 month period.  To apply for this you must do the following.

1. A completed application
2. Licensure fee
3. Age:  Evidence of at least 21 years of age (i.e.:  driver’s license, birth certificate, marriage license, school transcript, US State ID card, Military ID, or similar documentation);
4. If you hold or have held a credential to provide health services, health related services, or hearing aid services in Nebraska or in another jurisdiction, you must have the licensing agency submit to the Department a certification of your credential;
5. If you have had any disciplinary actions taken against your credential, you must submit a copy of the disciplinary action(s), including charges and disposition;
6. Conviction Information:  If you have been convicted of a felony or misdemeanor, you must submit:

1. A copy of the court record, which includes charges and disposition;
2. Explanation from the applicant of the events leading to the conviction (what, when, where, why) and a summary of actions you have taken to address the behaviors/actions related to the convictions;
3. All addiction/mental health evaluations and proof of treatment, if the conviction involved a drug and/or alcohol related offense and if treatment was obtained and/or required; and
4. A letter from the probation officer addressing probationary conditions and current status, if you are currently on probation;

7. An official transcript (official means issued and sealed by the issuing institution) showing completion of a four-year course of study from an accredited high school; or an official copy of a diploma or certificate from an accredited high school or its equivalent.

8. Official documentation of passing an examination which consists of a written and practical examination.  These exams need to be equivalent to the exams given by Nebraska.

9. Citizenship, lawful permanent residence, and/or immigration status Information:  You must submit a copy of at least one of the following documents:

1. A U.S. Passport (unexpired or expired);

2. A birth certificate issued by a state, county, municipal authority or outlying possession of the United States bearing an official seal;

3. An American Indian Card (I-872);

4. A Certificate of Naturalization (N-550 or N-570);

5. A Certificate of Citizenship (N-560 or N-561);

6. Certification of Report of Birth (DS-1350);

7. A Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240);

8. Certification of Birth Abroad (FS-545 or DS-1350);

9. A United States Citizen Identification Card (I-197 or I-179);

10. A Northern Mariana Card (I-873);

11. An Alien Registration Receipt Card (Form I-551, otherwise known as a “Green Card”);

12. An unexpired foreign passport with an unexpired Temporary I-551 stamp bearing the same name as the passport;

13. A document showing an Alien Registration Number (“A#”) with visa status; or

14. A Form I-94 (Arrival-Departure Record) with visa status;

Standards for Supervision: Any person who practices as a temporary hearing instrument specialist must be supervised by a licensed hearing instrument specialist.

The supervisor must meet with the temporary licensee face to face twice a month during the first 90 days of the initial training session, which will commence upon the issuance of the temporary license. Thereafter, the supervisor must meet with the temporary licensee monthly to evaluate the temporary licensee’s performance in the following areas:

1. Audiometric evaluations;

2. Impressions;

3. Purchase agreements;

4. Instrument orders;

5. Hearing instrument fittings; and

6. Consultation advice and training.

The supervisor must train the temporary licensee in the following areas during the initial 90 day training period:

1. Basic physics of sound;

2. The anatomy and physiology of the ear;

3. The function of hearing instruments;

4. Pure tone audiometry, including air conduction testing and bone conduction testing;

5. Live voice or recorded voice speech audiometry;

6. Masking;

7. Recording and evaluation of audiograms and speech audiometry to determine proper selection and adaptation of a hearing instrument; and

8. Taking earmold impressions.

The supervisor of a person who holds a temporary license must immediately notify the Department when supervision of the temporary licensee is terminated.  Upon completion of the initial training the supervisor must document the training on a form provided by the Department and referenced in these regulations as Attachment P

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Examination Requirements

The qualifying examination for Hearing Instrument Specialist is administered by the Department. The practical examination is developed by the State of Nebraska and the written examination is developed by the International Hearing Society (IHS).

To apply to take the examination, please contact:

Hearing Instrument Specialist
Licensure Unit
PO Box 94986
Lincoln, NE 68509-4986
(402) 471-2299

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Fees

Fee Schedule

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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

Continuing Education Approval Application
Duplicate/Reissue Form
Hearing Instrument Specialist Application
Name Change Form
Temporary Hearing Instrument Specialist Application
Reinstatement

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Renewal Information

All Hearing Instrument Specialist licenses expire December 31 of each even-numbered year. Licensing Unit will send all active license holders a renewal notice at least thirty (30) days before December 31 of each even-numbered year to the license holder’s last address of record.

The licensee must choose one of the following options during the renewal period:

1. Pay the renewal fee and return the completed renewal notice along with the continuing education affidavit; or
2. Place his/her license on inactive status by selecting the inactive option and returning the completed renewal notice;

Inactive means that you cannot practice but may represent yourself as having an inactive license. To change from inactive to active status you must meet renewal requirements which are in effect at the time status change is requested.

All Temporary Hearing Instrument Specialist licenses will expire 12 months from the date of issuance. Licensing Unit will send all active temporary license holders a renewal notice at least thirty (30) days prior to the expiration of his/her license to the licensees last address of record. If the Licensee chooses to renew they must pay the renewal fee for an additional year. The temporary license holder can practice on a temporary license for a total of 24 months.

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Reinstatement

An individual whose credential has expired, been placed on inactive status, voluntarily surrendered unrelated to discipline, been placed on lapsed status or non-disciplinary revocation may apply for reinstatement at any time.  The applicant must:

1. Submit a completed reinstatement application;

2. Obtain 24 hours of continuing education according to 172 NAC 75; and

3. Pay the fee(s):

• If the credential is expired, inactive, lapsed or non-disciplinary revocation, the reinstatement fee of $35 and the renewal fee; or

• If the credential was voluntarily surrendered, the renewal fee.

An individual whose credential was suspended or limited may apply for reinstatement at any time.  An individual whose credential has been revoked may apply for reinstatement after a period of two years has elapsed from the date of revocation.  An individual whose credential was voluntarily surrendered in lieu of discipline may apply for reinstatement according to the order entered by the Director.   To apply for reinstatement, the individual must contact the Licensure Unit for further direction. (402-471-2299)

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Continuing Education

Continuing education means planned, organized learning activities designed to maintain, improve, or expand a licensee’s knowledge and skills in order for the licensee to develop new knowledge and skills relevant to the enhancement of practice, education, or theory development to improve the safety and welfare of the public. Click here for a listing of approved Continuing Education Courses for the current renewal period.

To renew the license, all Hearing Instrument Specialists must have completed twenty–four (24) contact hours of approved continuing education within the two years proceeding the renewal period. Click here for the listing of approved Continuing Education for 2007-2008.

Subject matter acceptable for continuing education credit is described as follows:

• Approved programs at State and National Meetings, i.e., and Nebraska Hearing Instrument Society and/or the National Hearing Instrument Society;
• Formal education courses which relate directly to the practice of Hearing Instrument   Specialists;
• University sponsored courses in continuing education;
• Any other types of activity that may be approved by the Board of Hearing Instrument Specialist; and
• Licensee acting as essayist, or lecturer to licensed Hearing Instrument Specialist.
• Formal self study where the content of the self study activity relates to the practice of Hearing Instruments whether the subject is research, treatment, documentation, education, or management, e.g. videotapes, internet courses, and correspondence courses.  Licensees may complete a maximum of 6 hours of continuing education by self study each renewal Period.

• Busines, Management and Marketing courses which pertain to the practice of Hearing Instruments.  Licensees may complete a maximum of 8 hours of continuing education utilizing Business, Management, and Marketing courses in a renewal period.

The Board shall evaluate applications from providers of continuing education programs in order to determine if approval is to be granted or denied. To be approved, a continuing education program must meet the following criteria:

• The program must be at least sixty minutes in duration;
• The program’s objectives must relate directly to the theory or clinical application of theory pertaining to the practice of Hearing Instrument Specialist;
• The presenter of the program must be qualified by education, experience, or training; and
• Programs must be open to all Hearing Instrument Specialist licensed in Nebraska.

The provider must submit to the Board an Application for Approval of a Continuing Education Program on a form provided by the Department. The following information must be included in the application:

• A description in detail of program content;
• A description of program objectives;
• A description of the qualifications of each presenter;
• The number of hours for which approval is requested;
• The name, address, and telephone number of the provider and its administrator or operating officer;
• A description of the process the provider uses to verify attendance by the licensee;
• A sample copy of the documentation the provider issues to the licensee as proof of attendance at the program; and
• Date, time and place of program.

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Name and Address Change

To request an address change, you can call (402) 471-2299. If you wish to change your name on your Licensing & Regulatory Affairs record, you must mail a written request with your signature notarized along with a copy of the legal document verifying name change to:

Licensure Unit, Michelle Humlicek
Hearing Instrument Specialist
PO Box 94986
Lincoln NE 68509-4986

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Duplicates/Reissue

Duplicates: A duplicate large license or small license card may be requested at the time of initial licensure. A $10.00 fee, per document, is required.

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, and include a fee in the amount of $10.00 per document. Submit said request to:

Licensure Unit, Michelle Humlicek
Hearing Instrument Specialist
PO Box 94986
Lincoln NE 68509-4986

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Rules and Regulations/Statutes

Regulations relating to Hearing Instrument Specialist - 172 NAC 75
Statutes relating to Hearing Instrument Specialist
Statutes relating to the Uniform Licensing Law
Regulations relating to Mandatory Reporting
Mandatory Reporting Forms

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Contact Us

Office Address:

Mailing Address	Physical Address
DHHS, Public Health Licensure Unit PO Box 94986 Lincoln, NE 68509-4986	Nebraska State Office Building 301 Centennial Mall South 14th and M Streets 3rd Floor Lincoln, Nebraska

Phone: (402) 471-2115
Fax: (402) 471-3577

Office Hours:

8:00 a.m. to 5:00 p.m. (central time)
Monday through Friday

HIS Licensing Questions:

Diane Hansmeyer
Section Administrator
Phone: (402) 471-2299
e-mail: diane.hansmeyer@nebraska.gov

Delores James
Licensing Coordinator
Phone: (402) 471-2299
email: delores.james@nebraska.gov

Michelle Humlicek
Health Licensing Specialist
(402) 471-2299
email: michelle.humlicek@nebraska.gov

HIS Scope of Practice, Continuing Education & Board Related Questions:

Delores James
Licensing Coordinator
Phone: (402) 471-2299
e-mail: delores.james@nebraska.gov

HIS Scope of Practice Questions

Diane Hansmeyer, Section Administrator
Phone: (402) 471-2299
e-mail: diane.hansmeyer@nebraska.gov

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Board Information

The Board of Hearing Instrument Specialists advises the Department of Health and Human Services Regulation and Licensure on all issues related to the regulation of Hearing Instrument Specialists. Board member composition and length of terms follows:

The Board of Hearing Instrument Specialists meets at least 1 time per year - see Board meeting Schedule for meeting dates and times. Meetings are open to the public, with the exception of investigational matters. Minutes of meeting are available here or by contacting Delores James at (402) 471-4908 or by e-mail at delores.james@nebraska.gov

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Brochures

Chemical Dependency in Health Care Professionals

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Certification/Verification

Certification and Verification information can be obtained by checking the website at: www.dhhs.ne.gov/lis/lisindex.htm

OR

To request either a certification or verification or your license to be sent to another Licensing & Regulatory Affairs/state licensing agency, send your request in writing along with the proper fee to the our office. Checks should be made payable to Licensure Unit, State of Nebraska.

Certification

1. Fee - $25.00
2. Certification includes:
   1. Name
   2. Profession
   3. License number
   4. Issuance date
   5. Expiration date
   6. Whether the license was granted by examination, waiver, or reciprocity
   7. Examination information, if available
   8. Whether disciplinary action has been taken against the license. If so, the type(s) and date(s) of the action will be included.
   9. SEAL of the Nebraska Department of Health & Human Services

Verification

1. Fee - $5.00
2. Verification includes:
   1. Name
   2. Profession
   3. License Number
   4. Expiration Date
   5. Department Staff Signature

A verification does not include the SEAL of the Nebraska Department of Health & Human Services nor information relating to discipline, school, or examination.

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Licensee Assistance Program

The Licensee Assistance Program (LAP) is an assessment, education, referral, case management, and monitoring service designed to help licensees, certificate holders, and registrants of the State of Nebraska work through substance abuse/addiction problems.

The LAP services are free. However, in some cases treatment from a community resource agency may be needed. If further assistance is needed, the LAP Coordinator will help refer the Licensee to the most appropriate agency. When a treatment referral is made, those expenses become the responsibility of the Licensee.

This program was established by Neb. Rev. Stat. § 71-172.02 and is funded by the addition of $1.00 per year to the current fee for each license issued, renewed, or reinstated.

LAP telephone number: (800) 851-2336 or (402) 354-8055. You may also visit their website at www.lapne.org.

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Complaints

How do I file a complaint? To file a complaint, see the Investigations Division web site: www.dhhs.ne.gov/reg/investi.htm

What activities must be reported by a licensee, certificate holder, or registrant?

Every credentialed person who has first-hand knowledge of unlicensed, illegal or unethical activities is required to report (includes self-reporting) within 30 days of the occurrence. Failure to report may result in discipline. To view additional information relating to mandatory reporting, click on the options below:

• Mandatory Reporting Forms
• Mandatory Reporting Summary (chart showing who is to report and what is to be reported)
• Mandatory Reporting Regulations

Mandatory Reporting shall not apply:

• to the spouse of the person,
• to a practitioner who is providing treatment to such person in a practitioner-patient relationship concerning information obtained or discovered in the course of treatment unless the treating practitioner determines that the condition of the person may be of a nature which constitutes a danger to the public health and safety by the person's continued practice, or
• when a credentialed person who is chemically impaired enters the Licensee Assistance Program authorized by Neb. Rev. Stat. § 71-172.01 except as provided in such section.

How is a complaint reviewed, and what is the disciplinary process? The following provides information relating to the complaint, investigative, and disciplinary process.

• Investigations web site www.dhhs.ne.gov/reg/investi.htm
• Disciplinary Process Chart
• Uniform Licensing Law

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