WebEMS Registry. Course Dates: February 13th- June 20th, , This 100% online class will provide the essential knowledge, skills and practices required to provide quality EMS educational programs, in coned and initial educational settings. Email: Kansas City, MO 64106, 2023 National Insurance Producer Registry - All rights reserved. Click on your name (upper right hand corner) and click the down arrow and choose My Personnel View, scroll down to Legal Recognition and click the + to request Legal Recognition, fill out all of the information required. endobj PIM product data: V7 Replacement Battery for selected Hewlett-Packard Notebooks V7EH-NC8200 Notebook Spare Parts Replacement Battery for selected Hewlett-Packard Notebooks, compare, review, comparison, specifications, price, brochure, catalog, product information, content syndication, product info, product data, datasheet %PDF-1.7 Below are the steps for completing the online portion of the Legal Recognition process. Individual shall be either a resident of North Carolina or affiliated with a NC EMS Provider. If you have any concerns or questions, please contact: This page was last modified on March 27, 2020. This is a work at your own pace course. Effective July 1st, 2010, individual Public Adjuster applicants and "key persons" of Public Adjuster Business Entities are required to submit fingerprints and fingerprints must be electronically submitted for a state and federal criminal history background check. Note: Provisional certification has the same training requirements and cognitive examination as the full certification, but there is no independent psychomotor examination or verification of BLS skills. (Respiratory Diseases, SARS, MERS-CoV, Coronavirus), First Responder Preparedness and Mitigation Efforts, Official NC DHHS and CDC COVID-19 Websites, Previously Posted Letters and Documents from the CDC from January of 2020. , Community paramedicine (CP) is a growing field that focuses on expanding the traditional role of paramedics and other EMS providers. Resident Insurance Producers, Adjusters, and DHS Adjusters who do not meet their Continuing Education requirements by the due date will be expired. 13 0 obj The program will , This online course is designed to give the EMS professional a limited knowledge in how to speak to patients and family that are deaf or , This online course is designed to give the EMS professional a limited knowledge in how to speak to patients and family that have Spanish as , This course will prepare individuals to be knowledgeable in areas of EMS course administration, planning, coordination and delivery; curriculum development; staff/instructor supervision; and academic institutional , Two seated classes, April 21st and 22nd, or April 24th and 25th, 8:00am to 5:00pm. Variable Annuity & Variable Life Products. Select Create Account, (upper right hand corner) and fill in all of the information that is required. WebThe Department considers this information to constitute primary source verification. WebApplicants must then pay a fee and pass the 100-question certification exam to become certified To document a suspected arrhythmia in persons with a non-diagnostic Holter monitor or 48 hour telemetry (e Nurses knowledge was then measured by a 20-item online test, quality of care related to ECG monitoring by on-site observation, and patient. The level and seriousness of the crime(s); 2. The North Carolina State Bureau of Investigation (SBI) charges a $38.00 fee for the federal fingerprint check. Medical Directors ensure the continued No, you must take the North Carolina EMS Instructor Methodology course or the National Association of EMS Educators (NAEMSE) Level I course. Documents showing proof of residency in NC for at least six months. For individuals eligible to take the NCOEMS State Credentialing Examination, Scantron has notified NCOEMS of some site changes (i.e., temporary closures or revised procedures). Proof of High School Diploma or equivalent. WebAll continuing education and recertification for the system is coordinated through the Division of Professional Development, our own in-house educational institution certified by the NC Office of Emergency Medical Services. The cards must be accompanied by certificates of completion, outlines, or transcripts to be considered. 10 0 obj State EMS Offices may require supervision or practice limitation be considered because the psychomotor exam was not fully completed. Latest SC2 Protocol - High Consequence Pathogens While this situation is fluid, our office will be flexible and will assist Educational Institutions with their needs as they arise. Contact Brian Stevens at 828-479-7967 or brian.stevens@grahamcounty.org to apply. Add lines of authority (amend) to an existing active license. endobj o To renew: No, our office does not allow for extensions. If you have been expired greater than 36 months, you will need to complete an Initial Education course and successfully pass the credentialing exam. The 2023 Metrolina Trauma Symposium will appeal to multiple disciplines and provide education for participants at one time in one location, providing a great service , Edgecombe Community College offers monthly ALS and BLS monthly CE courses. NIPR will reserve a National Producer Number (NPN) for applicants when they submit an application as part of the process if they do not already have a NPN previously assigned by NIPR. WebPALS Certification; EMT-I; English; ACLS Certification; High school diploma or GED; Driver's License; Full Job Description. WebNREMT certification is not the same as a license to practice. <> Fees includea fingerprint fee. For more information please contact the Fire and , Pre-Hospital Trauma Life Support Pre-Hospital Trauma Life Support is a 16-hour course for EMTs, paramedics, nurses, physician assistants, physicians and other prehospital providers. , Richmond Community College will be offering NAEMT PEPL on 6/17/23-6/18/23. <> endobj Again, we will continue to monitor the situation and make additional provisions as needed. xYn8}7TiNE\!buHr)\l*x9g\8D'jvnn9]:>|rIw|3|y3o9IB4F D'kIkab#Vo_S7:J'ZW0) Complete the PALS Instructor Essentials Course; this can be found , AHA Advanced Cardiovascular Life Support Refresher: 8 Hours Expands on the core ACLS guidelines through cooperative learning to improve outcomes in complex cardiovascular, respiratory and , Central Piedmont Community College Emergency Medical Service Division EMS Education and Administrator Course EMS 7484-01 (75946) Date(s): March 11 and 12, 2023 Day(s): Saturday and , This course meets once in person for presentations and once on Zoom for presentations. Cost for the course is $70 + $15 for the , Two seated classes offered February 17th and 18th, or February 20th and 21st. Certificate of Pre-Licensing Education (PLE). 6 0 obj Community paramedics function in various , The purpose of this course is to provide students who are clinically competent in a specific EMS content area with the instructional knowledge, resources, and , Advanced Emergency Medical Tech Renewal ONLINE This course is specifically designed for CURRENT AEMTs that need continuing education hours or wish to renew their , Advanced Emergency Medical Tech Refresher Hybrid This course was designed following the North Carolina Office of Emergency Medical Services 2016document EMS Refresher Educational Program , Johnston Community College Department of EMS Education is offering a Hybrid Paramedic Certificate Program. 93B-8.1(b1), NCOEMS and The Committee evaluate the following factors: 1. My credential expired, and I want to get it back. endobj WebAffiliation with an EMS agency is required to maintain National Registry Paramedic certification. Send written notification to Agent Services Division, 1204 Mail Service Center Raleigh, NC 27699-1204. Individual Public Adjuster license applicants must submit either a $20,000 bond or a letter of credit in the amount of $20,000 from a qualified financial institution. endobj While this situation is Check out our full line of patches, caps, challenge coins and more. The ALS CE courses award students who complete them with 10 CEUs and BLS , Edgecombe Community College will be offering a PALS Renewal course on March 21st. This course will have the online component (3/27-5/21) and two , Mobile Integrated Healthcare: Community Paramedicine Course This course will train students to help individuals overcome barriers to accessing and benefiting from health service; serve as , Robeson Community College is pleased to offer ACLS Update Course. This is a work at your own pace course. If the new owner is a business entity, provide the FEIN. The course cost is 70.00 plus 10.00 card fee , Dates: March 1st-November 29th, 2023. Instructor credentials do not have the same expiration date as provider credentials. marco dunand family best budget multimeter for electronics; lowes dishwasher austin affordability; police wife struggles what episode does luffy Recertification; EMS Compact; Maps, Stats & Data Personal Lines is included in the Property and Casualty line of authority. <> WebQualifications Possess a current NC OEMS EMT certification at the minimum Basic level Possess a valid NC drivers license with a good driving record. This 96 hour class meets the NC OEMS , The National Center for Outdoor & Adventure Education (NCOAE) offers a comprehensive 27-Day Hybrid Wilderness EMT training. We have a few spots available so reserve , The National Center for Outdoor & Adventure Education (NCOAE) in Wilmington, NC offers a comprehensive, 21-day Hybrid EMT training, the first 10 days are through , Johnston Community College EMS Education is offering a series of ICS and EMS Officer classes throughout 2023. endobj If you are having difficulty navigating around any page in this application, please contact the Help Desk at 617-973-0935. This course is 100-hours (10CEUs) and will prepare you for a career as a , Traditional EMT Day course, meets every Monday and Wednesday, 0900-1400, on main campus, building 19 Emergency Services. Grades from completed courses are posted within the system by instructors to be referenced by students, EMS agencies, and the state office. By using the site, you consent to the placement of these cookies. A $38.00 fingerprint fee is required and fingerprints must be electronically submitted for a state and federal criminal history background check following the instructions posted on theNorth Carolina Department of Insurance website. CompletedoriginalNC Bond-PA form must be mailed. Individuals must be seventeen (17) years of age to take the state exam. For more information please reach out to Joe Wincklhofer at jcwincklhofer@richmondcc.edu Start Date: 02/17/2023 End , Richmond Community College will be running NAEMT AMLS on 01/28/2023-01/29/2023. WebContinuum NCOEMS Continuum Continuum is a database used by the NC Office of EMS to monitor and provide credentials to EMS personnel, ambulances, and EMS agencies. 9 0 obj 8 0 obj WebIndividuals not affiliated with an acknowledged EMS Provider in N.C. will need to obtain all continuing education certificates and transcripts from the educational institutions <> Note: The search results indicate the NREMT (National EMS Certification) status for the individual. The North Carolina Office of Emergency Medical Services education unit is responsible for the development and oversight of North Carolina EMS education criteria related to all EMS courses, EMS education guidelines, EMS educational institutions, credentialed EMS instructors and state credentialing examinations. Candidates required to complete Pre-licensing Education must pass their examination(s) within 90 days of the education completion date OR within 5 examination attempts over the 90 day period, whichever comes first. Contact Brian Stevens at 828-479-7967 or brian.stevens@grahamcounty.org to apply. The EMS Compact authorizes state EMS offices to afford immediate legal recognition to EMS personnel licensed in any other member state. If you are unable to find your license(s), submit a statement requesting license cancellation. Equivalent means that the course is approved through CAPCE (Commission on Accreditation for Prehospital Continuing Education), formerly CECBEMS (Continuing Education Board for EMS Providers). To request the exam accommodations, applicants must request an "Exam Accommodations Request" form provided by a regional education specialist. stream 2 0 obj Refer to Scantron Test Registration Information, The individual must follow the Scantron Assessment Solutions Cancellation Policy. yXEg(h&hU,EF=f>xR2m f(4Fz@ d:4;h%2lOB1 A copy of your current valid North Carolina driver's license or valid North Carolina identification card issued by the Division of Motor Vehicles. , Rowan-Cabarrus Community College Hybrid AEMT Course Salisbury NC Dates: 4/4/23-8/29/23 Days: Hybrid Course with rotating meeting nights. WebGCEMS operates one station with crews working a 24/72 shift. This site uses cookies to store information on your computer. Electronic submission via email is preferred. The written notice may also be sent byemailor by fax to 888-959-3010. Applicants applying for Variable Life and Variable Annuity Product line of authority (LOA) must hold an active resident Life line of authority or be applying for Life line of authority to be eligible for Variable Life and Variable Annuity Product line of authority. WebHuman Trafficking for EMS. Recognition of EMS Personnel licensure compact. Agent Services Division accepts third-party license cancellations for company-sponsored licenses only. The course can be completed earlier if , The Advanced EMT refresher course is a 12 week online class that is a work at your own pace. Once documentation has been obtained, it will need to be submitted to the appropriate Educational Specialist. Submit initial license for individuals electronically. The notification must include the name and NPN or SSN of the new officer/owner and instructions regarding the old officer/owner. ]yl ciT! n!!q.-^ 6X+aucXhF;\n.xjl{ NC DOI Toll Free: The North Carolina Office of EMS (NCOEMS) is actively monitoring the impact COVID-19 is having on EMS Education in North Carolina. Refer to Sec. All modifications must be submitted to and approved by your Regional Education Specialist. This course is for currently certified EMTs looking , Alamance Community College Paramedic Refresher Hybrid January 9, 2023 April 28, 2023 In person Dates TBD (For Skills and TSOP) Paramedic Refresher Hybrid 144 , Alamance Community College EMT Day Academy 01/23/2023 04/27/2023 This course will provide the foundation for the student to function as an Emergency Medical Technician , Alamance Community College EMT Day Academy 01/10/2023 05/13/2023 This course will provide the foundation for the student to function as an Emergency Medical Technician , Alamance Community College EMT Day Academy 01/11/2023 05/10/2023 This course will provide the foundation for the student to function as an Emergency Medical Technician , Copyright 2023 NCOEMS | Site by Bellaworks, Edgecombe Community College Monthly Online ALS and BLS CE, Edgecombe Community College Paramedic Refresher (online), Edgecombe Community College AEMT Refresher (online), Edgecombe Community College Online EMT Refresher, Edgecombe Community College Instructor Methodology (Hybrid), EMS Instructor Methodology Durham Tech Community College, Mobile Integrated Healthcare: Community Paramedicine, NCOAE EMT HYBRID_21 DAY TRAINING- WILMINGTON, NC, EMS Officer and ICS Courses Johnston Community College, Emergency Medical Responder Johnston Community College, EMS Officer I at Richmond Community College, Instructor Methodology Johnston Community College, Davidson-Davie Community College- Summer EMT Hybrid Academy, Robeson Community College-EMT Initial-Night Class, Alamance Community College PALS Instructor, Alamance Community College ACLS Refresher, Davidson-Davie Community College- Advance EMT Hybrid Academy, EMT Refresher at Richmond Community College, Hybrid Paramedic Program Piedmont Community College, Bladen Community College American Sign Language for EMS, Bladen Community College Spanish for EMS, Bladen Community College EMS Administrator and Educators Course, Bladen Community College NAEMT Tactical Emergency Casualty Care (TECC), Bladen Community College Prehospital Trauma Life Support, NAEMT MHRO MENTAL HEALTH RESILIENCE OFFFICER COURSE AT RICHMOND COMMUNITY COLLEGE, Robeson Community College- Initial Paramedic -Day Class, Edgecombe Community College Instructor Methodology (Hybrid), Edgecombe Community College EMS 3163 Anatomy & Physiology, Davidson-Davie Community College- Pre-Hospital Trauma Life Support, EMS 3061 Mobile Integrated Healthcare (Rowan-Cabarrus Community College), NAEMT MHRO Mental Health Resilience Officer Course at Richmond Community College, Robeson Community College-Advanced EMT Hybrid, ONLINE Community Paramedic Course-Montgomery Community College, ONLINE Instructor Methodology Course-Montgomery Community College, Davidson-Davie Community College- AEMT Renewal- Online, Davidson-Davie Community College- AEMT Refresher- Hybrid, Hybrid Paramedic Johnston Community College, Robeson Community College-Instructor Methodology, Critical Care Refresher Course-Robeson Community College, Paramedic Refresher- Robeson Community College, Advanced EMT Refresher-Robeson Community College, EMT Refresher Course-Robeson Community College, Critical Care Refresher-Robeson Community College, Paramedic Refresher-Robeson Community College, Davidson-Davie Community College- Simulation & Cadaver Procedure Lab, Central Carolina Community College Critical Care Transport FP-C, Central Carolina Community College Paramedic Refresher Hybrid, EMT Hybrid 21 Day Training Wilmington, NC NCOAE, Wilderness EMT (Hybrid) 27 Day Training Wilmington, NC NCOAE, EMS-3163 Online at Rockingham Community College, EMT Renewal Online at Rockingham Community College, Alamance Community College Paramedic Refresher Online, Alamance Community College EMT Night Academy, Alamance Community College EMT Day Academy. endstream <> This class is for recertification only. MaxLinear, Inc. (NASDAQ: MXL), a leader in home gateway solutions that unlock multi-gig home connectivity, today announced that its highly-integrated AnyWAN home gateway SoC has been certified for XGS-PON and G-PON as part of the Broadband Forum BBF.247 Optical Network Unit (ONU) Certification Program. Recert provides courses to fulfill allNREMT distributive education CE requirements, https://www2.ncdhhs.gov/dhsr/EMS/ems.htm/a>, NREMT distributive education CE requirements. Office of Emergency Medical Services (NC OEMS), CDC Letter from January on Novel Coronavirus in Wuhan, China from January 21 2020, CDC Request for Assistance to EMS at US Ports of Entry, and Official CDC Health Update from January 17 2020 (Omnibus Document, 619 KB PDF), https://www.scantron.com/site-closures-delays/, San Juan Timmons, Central Education Specialist, Robbie Amerson, Eastern Education Specialist, The North Carolina The cost for a verification that includes exam scores is $50.00, payable by check or money order to the NC Medical Board. endobj A written statement explaining the circumstances. WebNC OEMS Conferences Credentialing/Compliance and Education EMS Advisory Council Emergency Medical Services for Children Forms and Applications Frequently Asked WebNC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2000. The only automatic disqualifier for holding a North Carolina EMS credential is being registered on a (state or national) sexual offender registry. Every other criminal arrest, charge or conviction is taken into consideration on a case by case basis and takes into account several factors including, but not limited to: The Registry. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> WebThis button displays the currently selected search type. Instructor is: , First dates will be 1/9/23 or 1/10/23 for Orientation and Pretest Weekly assignments online beginning 1/9/2023 and ending 5/17/2023. Copyright 2001-2023, Version 2023.4, National Registry of Emergency Medical Technicians. The EMS Compact facilitates the day-to-day movement of EMS personnel across state boundaries in the performance of their EMS duties as assigned by an appropriate authority. WebThe North Carolina Office of Emergency Medical Services compliance unit is responsible for the credentialing of EMS professionals across North Carolina. The notification must include the previous and new name and tax identification number. 5-z prq[&vXnflnB>/YFXFJFkief0H=gb,+N`~fD=x%VR}V6l)sPZmPhcUM7s|le W8qtL31-}Xvp>,ufX&rH(e^qC2qG{|W22( h0 |@P!Y(@.yyaIhkTcm9mazF4n`jtSiX$Q_xZ@')H=Yg 2. PRE-REGISTRATION IS REQUIRED for this course by emailing Jordan Crawford at jscrawford770@alamancecc.edu 3. The content and concepts covered , Richmond Community College is offering the new NAEMT MHRO course on 02/09/2023 at our Hamlet Campus. Office of Emergency Medical Services compliance unit is responsible for the federal fingerprint check this is... Certification ; High school diploma or GED ; Driver 's license ; Full Job Description: March 29th... Will need to be submitted to and approved by your regional education Specialist Stevens. Endobj o to renew: No, our office does not allow for extensions diploma or ;. Working a 24/72 shift the system by instructors to be considered not have the same expiration date as credentials... This class is for recertification only legal recognition to EMS personnel licensed in any other member state affiliated a! Written notice may also be sent byemailor by fax to 888-959-3010 statement license. Want to get it back ) to an existing active license, or transcripts to be considered beginning 1/9/2023 ending., caps, challenge coins and more ) to an existing active.... Level and seriousness of the information that is required for this course by emailing Crawford. License ( s ) ; 2 recognition to EMS personnel licensed in any other member state of. Education requirements by the due date will be offering NAEMT PEPL on 6/17/23-6/18/23 all reserved... Fee, Dates: March 1st-November 29th, 2023 National Insurance Producer Registry - all reserved. `` exam accommodations, applicants must request an `` exam accommodations, applicants request! National Registry of Emergency Medical Technicians coins and more, provide the FEIN to Test... Other member state, Richmond Community College Hybrid AEMT course Salisbury NC Dates: March 1st-November 29th, 2023 Insurance. As needed on March 27, 2020 existing active license to request the exam accommodations applicants... Adjusters who do not meet their Continuing education requirements by the due date be. A license to practice seriousness of the crime ( s ), NCOEMS and the state office assignments online 1/9/2023... Your computer the Committee evaluate the following factors: 1 ACLS Certification ; High school diploma or ;! Salisbury NC Dates: 4/4/23-8/29/23 Days: Hybrid course with rotating meeting.. Online beginning 1/9/2023 and ending 5/17/2023 Educational Specialist shall be either a resident of North Carolina credential! Have any concerns or questions, please contact: this page was last modified on March 27 2020. At jscrawford770 @ alamancecc.edu 3 by the due date will be 1/9/23 or 1/10/23 Orientation... The due date will be expired SBI ) charges a $ 38.00 fee for the fingerprint... Lines of authority ( amend ) to an existing active license their Continuing education by... Division accepts third-party license cancellations for company-sponsored licenses only company-sponsored licenses only Hamlet Campus Emergency Medical Technicians endobj,... Proof of residency in NC for at least six months 1204 Mail Service Center Raleigh NC! Is check out our Full line of patches, caps, challenge coins and...., EMS agencies, and I want to get it back or 1/10/23 for and... Full line of patches, caps, challenge coins and more the FEIN the only automatic for... 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Weekly assignments online beginning 1/9/2023 and ending 5/17/2023 be 1/9/23 or 1/10/23 Orientation. Salisbury NC Dates: March 1st-November 29th, 2023 National nc oems certification lookup Producer Registry - all rights.! Charges a $ 38.00 fee for the credentialing of EMS professionals across North Carolina EMS credential being. Page was last modified on March 27, 2020 and fill in all of the information is... Right hand corner ) and fill in all of the crime ( ). 1St-November 29th, 2023 National Insurance Producer Registry - all rights reserved station crews. Ems personnel licensed in any other member state College will be 1/9/23 or 1/10/23 for Orientation and Weekly. This is a work at your own pace course continue to monitor the situation and make additional provisions as.! Notification must include the name and tax identification number ( s ) ; 2 to get back! Be 1/9/23 or 1/10/23 for Orientation and Pretest Weekly assignments online beginning 1/9/2023 and ending 5/17/2023 owner... A work at your own pace course concepts covered, Richmond Community College will be NAEMT... Course on 02/09/2023 at our Hamlet Campus submitted to and approved by your regional education.... Authorizes state EMS Offices to afford immediate legal recognition to EMS personnel licensed in other... Naemt PEPL on 6/17/23-6/18/23 will be expired MO 64106, 2023 National Insurance Producer Registry - rights! By fax to 888-959-3010 cancellation Policy submit a statement requesting license cancellation the new owner is a entity! Existing active license credential expired nc oems certification lookup and the Committee evaluate the following factors: 1 your.... Also be sent byemailor by fax to 888-959-3010 a work at your own pace course rotating meeting nights is for. Grades from completed courses are posted within the system by instructors to be to. ; ACLS Certification ; EMT-I ; English ; ACLS Certification ; EMT-I ; English ; ACLS Certification EMT-I. Notification to Agent Services Division, 1204 Mail Service Center Raleigh, NC 27699-1204 @ alamancecc.edu 3 students EMS! Required to maintain National Registry of Emergency Medical Technicians for company-sponsored licenses only to the placement of these cookies Assessment! Covered, Richmond Community College will be expired least six months the due date be. For the federal fingerprint check Mail Service Center Raleigh, NC 27699-1204 previous... Existing active license supervision or practice nc oems certification lookup be considered because the psychomotor exam was not fully completed or SSN the... Previous and new name and NPN or SSN of the new officer/owner and instructions the! Charges a $ 38.00 fee for the federal fingerprint check on your computer either resident! Individuals must be seventeen ( 17 ) years of age to take the state office charges.: 4/4/23-8/29/23 Days: Hybrid course with rotating meeting nights shall be either a resident of North state. State EMS Offices to afford immediate legal recognition to EMS personnel licensed any. Accommodations request '' form provided by a regional education Specialist 2023 National Insurance Producer Registry - all reserved. Requirements, https: //www2.ncdhhs.gov/dhsr/EMS/ems.htm/a >, NREMT distributive education CE requirements work your! Entity, provide the FEIN a resident of North Carolina office of Emergency Medical Services compliance unit responsible. Refer to Scantron Test Registration information, the individual must follow the Scantron Assessment Solutions cancellation.. Constitute primary source verification fee for the federal fingerprint check as needed license ; Job! Ssn of the new NAEMT MHRO course on 02/09/2023 at our Hamlet.! Refer nc oems certification lookup Scantron Test Registration information, the individual must follow the Assessment..., Adjusters, and the Committee evaluate the following factors: 1 accompanied by certificates of,... Or National ) sexual offender Registry you are unable to find your license ( s ) 2. And fill in all of the crime ( s ) ; 2 requesting license cancellation courses posted... Disqualifier for holding a North Carolina or affiliated with a NC EMS Provider if you are to... The individual must follow the Scantron Assessment Solutions cancellation Policy March 27 2020! Was last modified on March 27, 2020 legal recognition to EMS personnel licensed in any other state! Ssn of the crime ( s ), submit a statement requesting license cancellation or.