:: Initial Applications ::

Technician Application

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Waiver of Fee -- Determination of Eligibility

An applicant for an initial license or registration is eligible for a waiver of the initial fee(s) if the applicant’s adjusted gross household income does not exceed 200% of the Federal Poverty Level and the applicant is applying for this specific license/registration category for the first time.

To determine eligibility, you must first identify the number of individuals in your household. Once this is determined, reference the Federal Poverty Level and identify your adjusted gross income that matches the number of individuals in your household. If your adjusted gross household income, as reported on your most recent federal tax return, is less than the identified value, you are eligible for the one-time fee waiver.

If you determine that you are eligible for the one-time fee waiver, you will be provided an opportunity to request the waiver at the end of this application. You will also be required to upload a copy of your household Federal Tax Return for the preceding year.

If you are married and filed separately, you will need to submit the Federal Tax Return for both your spouse and yourself.
If you were claimed as a dependent on another person’s tax return, you will need to submit the Federal Tax Return for the tax filer who claimed you as a dependent.

Please be sure you have the required documents ready before proceeding with this application. If your documents are not available for upload when the waiver opportunity is presented, you will need to redo this entire application to request a fee waiver.

Certified Pharmacy Technician (CPhT) Registration

You are applying for an INITIAL Certified Pharmacy Technician (CPhT) registration. Prior to commencing CPhT employment, a CPhT registration is required for individuals who will be employed or practicing in a pharmacy, under the supervision of a pharmacist, to assist the pharmacist with technical functions associated with the practice of pharmacy. National pharmacy technician certification is required prior to registering as a CPhT in Iowa.

Registrations are issued administratively following review of a completed application and all required documentation, unless the application warrants referral to the Board, or unless a personal appearance is required.

Applications are valid for 45 days from the date of receipt. You will be notified by email if additional information is required. If a response is not received and the application surpasses 45 days in pending status, the application will expire and a new application and fee will be required if you wish to obtain an Iowa technician registration.

Failure to answer all questions completely or accurately, and/or omission or falsification of material facts may be cause for denial of your application, or disciplinary action if you are subsequently registered by the Board. If you are in doubt, answer “yes” and provide an explanation.

A CPhT must report to the Board a change of name, address, email address, place of employment, or employment status within ten days of the change.

Iowa Regulations

657 Iowa Administrative Code Chapter 3 governs the practice of a CPhT in an Iowa pharmacy.

Have you reviewed and do you understand the Iowa regulations pertaining to CPhTs?

Yes

Disclosure of Medical Conditions, Criminal History, and Disciplinary Action

Be advised that the application for CPhT registration asks about any medical conditions you have that might impair your ability to perform delegated technical functions. The Board also considers any prior criminal history and disciplinary actions when issuing technician registrations. As part of the application process you will be asked questions about prior criminal history and disciplinary actions.

If you have any questions concerning these requirements, please notify the Board office. If any of these situations pertain to you, there may be delays at the time of registration. We suggest you contact the Board office for information as to what documentation may be necessary for registration. Contacting the Board office about any of these situations may avoid unnecessary delays at the time of registration.

Definitions

Important! Read these definitions before completing this application.

“Ability to perform required pharmacy-related technical and nontechnical tasks with reasonable skill and safety” means ALL of the following:

The cognitive capacity to use pharmacy systems to obtain necessary patient and prescription related information to process prescriptions

The ability to effectively communicate information to pharmacists, interns, providers, other technicians, pharmacy support persons, and patients

The ability to perform required tasks such as filling prescriptions, compounding prescriptions, and other technical and nontechnical pharmacy services

“Medical condition” means any physiological, mental, or psychological condition, impairment, or disorder, including drug addiction and alcoholism.

“Chemical substances” means alcohol, legal and illegal drugs, or medications, including those taken pursuant to a valid prescription for legitimate medical purposes and in accordance with the prescriber’s direction, as well as those used illegally.

“Improper use of drugs or other chemical substances” means ANY of the following:

The use of any controlled drug, legend drug, or other chemical substances for any purpose other than as directed by a licensed health care practitioner; and

The use of any substance, including but not limited to, petroleum products, adhesive products, nitrous oxide, and other chemical substances for mood enhancement.

“Illegal use of drugs or other chemical substances” means the manufacture, possession, distribution, or use of any drug or chemical substance prohibited by law.

“Currently”does not mean on the day of, or even in weeks or months preceding the completion of this application. Rather, it means recently enough so that the use of chemical substances or medical conditions may have an ongoing impact on the ability to function and perform the duties required of a technician, or has adversely affected the ability to function and perform the duties required of a technician within the past two (2) years.

Required Documents

A Government-Issued Photo Identification (driver’s license, government issued ID, passport, etc.) is required to be uploaded with your application.

A copy of your current national certified pharmacy technician certificate (PTCB or NHA) is required to be uploaded with your application.

In addition, the following documents may be required to be uploaded with your application:

1. Description and documentation of the conviction(s) for any criminal history disclosed (Do not attach summaries or docket print outs from Iowa Courts Online).

a. You are strongly encouraged to perform a background check on yourself or to have your employer perform one prior to submitting your application. To search Iowa Courts online go to https://www.iowacourts.state.ia.us and click “Start a Case Search Here.” Keep in mind that this database only shows Iowa state court convictions. These instructions are not intended to provide a comprehensive criminal history background check, but rather a quick way for you to refresh your memory as to any Iowa state court convictions.

2. Description and documentation of the final disciplinary order(s) for any disciplinary history disclosed
3. Description and documentation of the final denial order(s) by a licensing authority.

Military or Veteran Status

1.Are you active duty military?

Yes

2.Are you a military veteran?

Yes

3.Are you the spouse of a active duty military member or veteran?

Yes

Prior Iowa Board of Pharmacy Licensure or Registration

Have you ever been licensed or registered with the Iowa Board of Pharmacy in any capacity?

Yes

Full Name

Street Address

C S Z

License #

Personal Information

Provide Full Legal Name

Last Name

First Name

Middle Name

Suffix

Maiden Name/Previous Name(s) Used

Date of Birth

Social Security #

Gender

NABP E-Profile ID number

If you do not have an NABP E-Profile ID number, you may create one by clicking here.

Has your name changed since your previous license or registration?

Yes

Document Type

Attach Name Change Document

Home/Permanent Address

Address 1

Address 2

Address 3

Country

Zip

City

State

County

Alternate Mailing Address (optional)

Check if mailing address is the same as physical address

Address 1

Address 2

Address 3

Country

Zip

City

State

County

Contact Information

Phone Type

Primary Phone #

Accept Text Message

Yes

Alternate Phone Type

Alternate Phone #

Accept text message

Yes

E-mail

Fax #

Current Employment

Iowa rules require that a registration be issued prior to the individual commencing work in a pharmacy. “Employment” means that you have been hired by a pharmacy, not necessarily that you have actually started working in the pharmacy. Please identify the pharmacy that has hired you and the date of hire to physically work within the pharmacy. If you have been working for a company in another capacity, but are just now to begin the duties of a pharmacy employee, indicate the date you are hired to perform duties for the pharmacy, not the initial date you were hired to work elsewhere within the company.

Do not indicate that you are not currently employed in a licensed Iowa pharmacy if you have been hired to work in a licensed Iowa pharmacy.

Are you currently employed in a licensed Iowa pharmacy?

Yes

Other State Licenses or Registrations

Do you or have you ever held a professional license/registration in Iowa or another state (this does not include drivers’ licenses)?

Yes

National Pharmacy Technician Certification

Provide your national pharmacy technician certification details:

Certification Type

Certification #

Status

Original Date

Expiration Date

Effective Date

Criminal History

Have you ever been convicted of a criminal offense, other than a minor traffic offense, in any jurisdiction? Conviction means a finding, plea, or verdict of guilt made or returned in a criminal proceeding, even if the adjudication of guilt is deferred, withheld, or not entered. Conviction includes Alford pleas and pleas of nolo contendere. You must submit the complaint and judgment of conviction for each offense, and a personal statement regarding whether each conviction directly relates to the practice of the profession. Your application will not be considered complete until all of this information is received by the Board.

Yes

Disciplinary Actions/History

Have you ever been disciplined by any licensing authority? Discipline includes, but is not limited to, citations, reprimands, fines, and license/registration restrictions, probation, suspension, revocation, or surrender.

Yes

Professional License/Registration Denials

Have you ever been denied a professional license or registration by any professional licensing authority?

Yes

Pending Investigations

Do you have any charges, or knowledge of any investigations or complaints, pending before any licensing authority?

Yes

Required Documents

Illegible copies will not be accepted.

1. Upload a copy of Government Issued Identification (driver’s license, government issued ID, passport, etc.)

2. Upload a copy of your current National Pharmacy Technician Certificate (PTCB or NHA)

Preview

Please review your application and return, using the Previous button, to any page(s) that needs to be changed or corrected.
Once you click the Next button on this page you will not be able to make any changes to your application.

Confirm and Submit

I acknowledge that it is my responsibility to timely renew the registration and to report any change of name, address, email address, place of employment, or employment status within 10 days of a change.

I hereby swear or affirm under the penalty of perjury that the information provided in this application is true and correct. I understand that failure to provide complete and truthful information may constitute grounds for denial, revocation, or other disciplinary sanctions against my CPhT registration. Information provided on this application may be disclosed pursuant to 657 IAC Chapter 14, subject to exceptions in federal and state law.

Signature

Date

Please allow 5-7 business days for processing.

You may check the status of a pending application at https://pharmacy.iowa.gov/initial-application-status-check

Once your registration has been issued it can be verified at https://pharmacy.iowa.gov/online-services/licenseregistration-verification

License/Registration Type

State Licensing Body

License/Registration number

License/Registration Status

License/Registration issue date

License/Registration expire date

License Type

License Number

Business Name

Address

Zip

City

State

Name of the PIC

Pharmacy email address

Exact date of hire as a Certified Technician, when you began working as a Certified Technician in the secured pharmacy area