The Minnesota R 20 form is the application for approval and registration as a Qualified Rehabilitation Consultant Intern. This form is essential for individuals seeking to work under the supervision of a Qualified Rehabilitation Consultant (QRC) in Minnesota. If you're ready to take the next step in your career, fill out the form by clicking the button below.
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The Minnesota R 20 form is essential for individuals seeking approval and registration as Qualified Rehabilitation Consultant Interns. Alongside this form, several other documents are often required to ensure a comprehensive application process. Below is a list of related forms and documents that may accompany the Minnesota R 20 form.
Completing the Minnesota R 20 form and accompanying documents accurately is crucial for a successful application. Ensuring all required materials are included will facilitate a smoother review process by the Department of Labor and Industry.
1. What is the purpose of the Minnesota R 20 form?
The Minnesota R 20 form is an application for approval and registration as a Qualified Rehabilitation Consultant (QRC) Intern. This form is essential for individuals who wish to work under the supervision of a licensed QRC in Minnesota. By completing this form, applicants provide necessary personal and professional information, including their education, work history, and any relevant certifications. The form helps ensure that those entering the field meet the state's requirements for training and supervision.
2. What information do I need to provide on the R 20 form?
When filling out the R 20 form, you will need to provide personal data, including your name, address, and contact information. Additionally, you must disclose whether you hold any professional licenses or certifications, such as CRC or CDMS. The form also requires details about your education, including official transcripts from postsecondary institutions, and a comprehensive employment history. You will need to indicate your supervisor's name and provide a plan of supervision if applicable. Lastly, a fee of $110 must accompany your application, payable to the Commissioner of the Department of Labor and Industry.
3. How do I submit the Minnesota R 20 form?
To submit the Minnesota R 20 form, complete all required sections thoroughly and ensure that you have attached any necessary documents, such as transcripts and proof of certifications. After gathering all materials, send the completed form along with your payment to the Financial Services Section of the Minnesota Department of Labor and Industry at the address provided on the form. It is advisable to keep a copy of your application and any attachments for your records.
4. What happens if I make a mistake on my application?
If you discover an error after submitting your application, it is crucial to address it as soon as possible. Mistakes or omissions can lead to delays in processing your application or even rejection. If you need to correct something, contact the Department of Labor and Industry directly at the phone numbers listed on the form. They can guide you on the best steps to rectify the situation and ensure your application is complete and accurate.
5. Is there a fee associated with the Minnesota R 20 form?
Yes, there is a fee of $110 associated with the Minnesota R 20 form. This fee is required to process your application and includes a 10% surcharge as mandated by state law. Payment should be made via check or money order, made out to the Commissioner of the Department of Labor and Industry. Ensure that your payment is included with your application when you submit it to avoid any processing delays.
Filling out the Minnesota R 20 form can be a straightforward process, but many applicants stumble over common mistakes that can delay their registration. One frequent error is neglecting to provide complete personal information. It’s essential to fill out every section thoroughly, including your name, address, and contact details. Leaving out even one piece of information can lead to confusion and may result in your application being returned.
Another common mistake involves the financial aspect of the application. Applicants often forget to include the required fee of $110. This fee is crucial for processing your application. Make sure to enclose a check or money order made out to the Commissioner of the Department of Labor and Industry. If you overlook this step, your application will not be processed until the payment is received.
Many people also fail to attach necessary documentation, which can be a significant setback. For instance, if you hold a professional license or certification, you must include a copy of it with your application. Additionally, official transcripts of your postsecondary education are required. Without these documents, your application may be deemed incomplete, causing unnecessary delays.
Lastly, applicants sometimes overlook the importance of providing detailed employment history. It’s not enough to simply list previous jobs; you should describe your duties and responsibilities in detail. This information helps the reviewing body understand your qualifications and experience better. Skipping this step can lead to questions about your background, which may prolong the approval process.
The Minnesota R-20 form is quite similar to the application forms used for various professional licenses and certifications in the healthcare and rehabilitation fields. One such document is the Certified Rehabilitation Counselor (CRC) application. Like the R-20, the CRC application requires detailed personal information, educational background, and work history. Both forms also necessitate proof of relevant qualifications, such as transcripts and licenses, underscoring the importance of formal education and experience in the rehabilitation profession.
Another comparable document is the application for the Certified Disability Management Specialist (CDMS) credential. This form shares similarities with the R-20 in that it demands comprehensive details about the applicant’s professional experience and educational qualifications. Both applications also include a section for supervisors to provide their endorsement, reflecting the collaborative nature of rehabilitation work. This requirement ensures that candidates are well-prepared to support individuals with disabilities effectively.
The application for the Registered Rehabilitation Vendor (RRV) in Minnesota is another document that aligns closely with the R-20. Both forms require applicants to disclose their employment history and any relevant certifications. Additionally, they emphasize the need for a supervisor's plan of supervision, highlighting the importance of mentorship in the rehabilitation field. This shared focus on oversight ensures that applicants are adequately supported as they navigate their professional responsibilities.
Forms related to state licensure for social workers also bear resemblance to the R-20. These applications typically require personal information, educational background, and work experience, much like the R-20. Both documents emphasize the need for applicants to demonstrate their qualifications and to provide verification from supervisors or other professional references, which helps maintain standards within the field.
The application for the Occupational Therapist License in Minnesota is yet another similar document. It requires applicants to provide extensive information about their education, clinical experience, and any relevant licenses or certifications. Like the R-20, this form includes a certification statement, ensuring that applicants understand the legal implications of their submissions. This serves to uphold the integrity of the licensing process.
Applications for the Licensed Professional Counselor (LPC) credential also parallel the R-20 form. Both documents require detailed personal and professional information, including educational history and supervision plans. The LPC application, like the R-20, necessitates a commitment to ethical practice and adherence to professional standards, reinforcing the importance of accountability in the mental health field.
In examining the various application forms in the rehabilitation and mental health fields, it becomes evident that comprehensive documentation is crucial for applicants to demonstrate their credentials effectively. Consequently, it's essential to understand related legislative frameworks, such as the Missouri Compromise, which reflects the importance of maintaining balance in decision-making processes. For those interested in further details and insights regarding such historical agreements, the Missouri PDF Forms provide valuable resources to explore the implications of the compromise in greater depth.
The application for the Certified Case Manager (CCM) credential shares similarities with the R-20 as well. Both forms require applicants to detail their work experience and educational qualifications, along with a supervisor’s endorsement. This ensures that candidates possess the necessary skills and knowledge to effectively manage cases and support clients in their rehabilitation journeys.
Another document that resembles the R-20 is the application for the Licensed Marriage and Family Therapist (LMFT) credential. Both require comprehensive background information, including education and work history, as well as a plan for supervision. This focus on mentorship and professional development is crucial in preparing candidates for the complexities of therapeutic practice.
Lastly, the application for the Certified Mental Health Rehabilitation Technician (CMHRT) credential is similar to the R-20. Both forms require applicants to provide detailed information about their education, work experience, and any relevant certifications. The emphasis on supervision and professional accountability in both documents highlights the collaborative nature of mental health and rehabilitation services, ensuring that clients receive the best possible support.
Minnesota Department of Labor and Industry Financial Services
443 Lafayette Road North St. Paul, MN 55155 (651) 284-5459 or
1-800-342-5354 (DIAL DLI) www.dli.mn.gov
Please PRINT or TYPE
PERSONAL DATA
R-20
Application for Approval and Registration
Qualified Rehabilitation Consultant Intern
NAME (last, first, middle)
ADDRESS (residence)
PROSPECTIVE EMPLOYER
CITY
STATE ZIP CODE
EMPLOYER ADDRESS (Your mailing address)
HOME PHONE NUMBER
BUSINESS PHONE NUMBER
1. Do you hold a professional licensure, certification or registration?
If yes, which certification?
CRC
CDMS Other:
Please attach a copy of any license/certification/registration.
Yes
No
2.Name of Qualified Rehabilitation Consultant (QRC) under whose supervision you will work.
3.Enclose a check or money order for $110.00 payable to the Commissioner of the Department of Labor and Industry. (This includes the 10% surcharge pursuant to 2009 Laws, Chapter 101, Article 2, Section 59.) Send all application documents and fees to the Department’s Financial Services Section at the above address.
4.Do you speak or write any foreign language? If yes, name language and number of years.
5. Are you able to communicate with the deaf in sign language?
6. Have you applied for registration as a QRC/Intern or a Registered Rehabilitation Vendor in Minnesota in the past?
If yes, give date(s)
EDUCATION DATA
ATTACH OFFICIAL TRANSCRIPTS OF ALL PERTINENT POSTSECONDARY EDUCATION
NAME OF SCHOOL
CITY/STATE
DATES ATTENDED
FROMTO
month/year month/year
DEGREE OR HIGHEST GRADE COMPLETED
Attach a list of continuing education within the past 2 months which pertains to this registration.
NOTE TO QRC SUPERVISOR: Please see Minn. Rules 5220.1400, subp. 3a and attach a plan of supervision addressing all of the requirements of this subpart.
MN R-20 (3/12)
over
EMPLOYMENT HISTORY
Describe in DETAIL your work history beginning with your current or most recent job. Attach an additional sheet, if necessary.
EMPLOYER NAME
PHONE NUMBER
IMMEDIATE SUPERVISOR NAME
ADDRESS
DATES (from and to)
STATE
ZIP CODE
JOB TITLE
Duties:
List or attach any other information that may be pertinent to registration (i.e., honors, peer recognition, etc.)
I authorize the Workers’ Compensation Division, Department of Labor and Industry to make any investigation of the application and supporting documents. I understand that any omission or misrepresentation may result in rejection or revocation of registration.
I hereby agree to be bound by all statutes, rules and orders and realize that violations may result in revocation of registration.
Subject to approval of this application I agree to notify the Workers’ Compensation Division, Department of Labor and Industry of any change in my employment status. Given a change in my employment status I will accept the responsibility to notify all parties to the case on which I am the assigned Qualified Rehabilitation Consultant Intern as to whom the reassignment will be made, subject to approval of the Commissioner of Labor and Industry.
I CERTIFY THAT I AM A FULL-TIME RESIDENT OF MINNESOTA, or I live no more than 100 miles by road from the Minnesota border. (Minn. Rules 5220.1400, subp. 5)
APPLICANT SIGNATURE
DATE
NOTARY FOR APPLICANT
MY COMMISSION EXPIRES
I hereby agree to provide the supervision outlined on the attached sheet and as provided by Minn. Rules 5220.1400, subp. 3a.
SUPERVISOR SIGNATURE
NOTARY FOR SUPERVISOR
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (651) 284-5459 or 1-800-342-5354/Voice or TDD (651) 297-4198.
Filling out the Minnesota R 20 form is an important step for those seeking approval and registration as a Qualified Rehabilitation Consultant Intern. Here are some key takeaways to keep in mind:
By following these guidelines, you can help ensure a smoother application process for your registration as a Qualified Rehabilitation Consultant Intern in Minnesota.