Declaration of U.S. Citizenship Information
The Beason-Hammon Alabama Taxpayer and Citizen Protection Act requires every person or sole proprietorship applying for certain licenses or permits to either demonstrate U.S. citizenship, or, if the person is an alien, to prove lawful presence in this country. The Alabama Department of Public Health will verify an applicant’s immigration status or naturalized/derived citizenship status using the SAVE Program effective August 1, 2016.
To comply with this law, ADPH requires the following for an initial permit or renewal application:
A business entity must provide a Declaration of Business Ownership Structure if the type of ownership or business entity is not clearly indicated on the application.
ADPH will only verify the status of the individual who is licensed or permitted. Demonstration of U.S. citizenship or lawful permanent residence is only required one time.
Individual Licensure Information
- EMSP License Requirements - Please read this document before filling out the application.
- EMS Individual Licensure Application - Complete the application and if you are a first issue, you must complete the Criminal History Information Release Form. It is not necessary to fill out the criminal history if you have already been licensed. Please be aware that walk-ins will not be processed during the license renewal period (January 1-March 31).
- EMS Individual Online Renewal - The online renewal capability is currently active. Please remember that all online renewal transactions are subject to a $2 annual fee for using this method of renewal. Individuals chosen for audit are required to fax requested documentation to (334) 206-0364 within 72 hours of the request.
- Effective August 1, 2016, Individual Licensure fees will increase to $12 for a 24-month license as required by new legislation.
- If you apply for renewal after April 1 of your expiration year, a $50 late fee will be added in addition to the new licensure fee.
Provider Licensure Information
- Provider Application - All plans and proof of liability insurance must accompany the application.
Online EMS Provider Licensure Application - The electronic renewal process is now active.
EMS Provider Licensure Application - This form is fillable and should be typewritten, not handwritten.
Bio-Hazardous Waste Plan Checklist
Controlled Substance Plan Checklist
I.V. Fluid/Drug Plan Checklist
Last Updated: December 27, 2016