Approved Provider Intent to Apply/Eligibility Verification

  • Approved Provider Intent to Apply and Eligibility Verification

  • Section 1: Demographic Data

  • Organizations interested in submitting an application for approval or renewal of approval as an Approved Provider must complete meet all eligibility requirements.  Verification forms received from organizations that do not meet eligibility requirements will be rejected without substantive review.

  • To determine your organization type, visit this link: Approved Provider Organization Types and Fee Information

  • Are you a current VNA Approved Provider?*

  • Section 2: Nurse Planners

  • All Nurse Planners have an unrestricted nursing (or international equivalent) and a baccalaureate degree (or international equivalent) or higher in nursing.*
  • If an applicant organization has multiple nurse planners, a primary nurse planner is utilized as the contact for the ANCC Accredited Approver Unit and ensures compliance with the ANCC accreditation criteria.*
  • Format: (000) 000-0000.
  • A Nurse Planner from the list below is an active participant in the planning, implementing and evaluation process of each continuing education activity.*

  • Section 3: Regional Target Market

  • During the past year, did the applicant organization promote/market/advertise more than half (51% or more) of its learning activities to nurses within the states of your region and the states contiguous to your region? NOTE: Marketing an activity on a national platform, such as a website, social media, or national publication, targets nurses outside of the HHS region.*
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  • For region information, refer to https://www.hhs.gov/about/agencies/iea/regional-offices/index.html.

  • Based on the responses provided, the applicant organization is not eligible to be an Approved Provider but may be eligible to apply as an Individual Activity Applicant. For more information about that process, please visit our website.

     

     If you believe this to be a mistake, you may return to the form to review and update your responses or email VNA's Accredited Approver Program Director, Kate Hildreth.

     

  • Section 4: Eligible Operations

    The applicant organization must answer the following questions and provide any additional required information.
  • The applicant has been operational for a minimum of 6 months using the ANCC Accreditation Criteria.*
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  • The applicant has assessed, planned, implemented, and evaluated at least three (3) separate educational activities, within the past 12 months, provided at separate and distinct events, with the direct involvement of one of the Nurse Planners listed above and adhere to the ANCC Accreditation Program Criteria. If applying as a NEW applicant, each learning activity must be at least 1 hour (60 minutes) in length, contact hours may or may not have been offered, and the activities not jointly provided.*
  • The applicant organization is in compliance with all applicable Federal, State, and Local laws and regulations that apply to the delivery of NCPD.*

  • Section 5: Ineligible Company

    The following section is intended to collect information about the applicant organization’s corporate structure. NOTE: Companies that are ineligible to be approved (ineligible companies) are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Certain organizational types are automatically eligible and exempt from the definition of an ineligible company, as per the Standards for Integrity and Independence in Accredited Continuing Education.

  • NOTE: 501c organizations are not automatically exempt. The ANCC Accreditation Program requires 501c organizations to be screened for eligibility.

  • Is your organization one of the following? Check the applicable box:*

  • Section 6 - Applicant Organization is NOT Exempt

  • According to your answer above, the applicant organization is not exempt from the Standards for Integrity and Independence in Accredited Continuing Education definition of an ineligible company. The following questions must be answered, so Virginia Nurses Association can assess the applicant organization's eligibility.

    Note: Companies whose primary business is producing, marketing, re-selling, or distributing healthcare products used by or on patients are ineligible for approval per the Standards for Integrity and Independence in Accredited Continuing Education as an ineligible company.

  • 1. Does your organization, or a part of your organization, produce, market, re-sell, or distribute healthcare products used by or on patients?*
  • 2. Does your organization advocate for an ineligible company?*
  • 3. Does your organization have a non-primary business function that includes producing, marketing, reselling, or distributing of healthcare products used by or on patients and/or advocating for, or on behalf of an ineligible company?*
  • 3A. Is the nonprimary business function, which led to the answer yes, conducted by a separate legal entity with separate management and staff from the entity applying for accreditation??*
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  • 4A. Does your organization have a parent company that produces, markets, re-sells, or distributes healthcare products used by or on patients?*
  • 4B. Does your organization have a parent company that advocates for, or on behalf of, an ineligible company?*

  • A "sister company" is a separate legal entity which is a subsidiary of the same parent company that owns or fiscally controls an organization.

  • 5A. Does your organization have a sister company that produces, markets, re-sells, or distributes healthcare products used by or on patients?*
  • 5B. Does your organization have a sister company that advocates for, or on behalf of, an ineligible company?*
  • 6. Does your organization share management, employees, or governance structure with the sister company?*
  • 7. Are any owners, employees, or agents of the sister company involved in the planning, development, or implementation of educational content?*
  • 8. Does the sister company control or influence, in whole or in part, the operations of your organization?*

  • Based on the responses provided, the applicant organization is not eligible to be an Approved Provider.

     

     If you believe this to be a mistake, you may return to the form to review and update your responses or email VNA's Accredited Approver Program Director, Kate Hildreth.

     

  • Section 7: Statement of Understanding

  • I attest, by my signature below, that I am duly authorized by {nameOf} to submit this application as an approved provider offered by the American Nurses Credentialing Center (ANCC) through Accredited Approvers and to make the statements herein. On behalf of {nameOf}, I have read the approved provider eligibility requirements and criteria. I understand that the {nameOf} is subject to all eligibility requirements and criteria as an approved provider. I understand that becoming an approved provider depends on successfully meeting eligibility requirements and criteria and maintaining approved provider standing is dependent upon continued compliance. 

    On behalf of {nameOf}, I expressly acknowledge and agree that information accumulated through the approval process may be used for statistical, research, and evaluation purposes and that anonymous and aggregate data may be released to third parties.  Otherwise, all information will be kept confidential and shall not be used for any other purposes without {nameOf}’s permission.

    On behalf of {nameOf}, I hereby certify that the information provided on and with this application is true, complete, and correct.  I further attest, by my signature on behalf of {nameOf}, that {nameOf} will comply with all eligibility requirements and approval criteria throughout the entire approval period, including all reapplication periods for maintaining approval, and that {nameOf} will notify Virginia Nurses Association promptly if, for any reason while this application is pending or during any approval period, {nameOf} does not maintain compliance.  I understand that any misstatement of material fact submitted on, with or in furtherance of this application for approved provider status shall be sufficient cause for Virginia Nurses Association to deny, suspend or terminate {nameOf}’s approved provider status and to take other appropriate action against {nameOf}. 

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  • Invoicing Information

  • By submitting this form, I attest that I understand it is my responsibility to contact my organization's accounting department to determine what is needed for timely payment of Approved Provider invoicing. Specific payment details must be sent to khildreth@virginianurses.org. Approved Provider invoices will be sent six months prior to application due date. 

  • Format: (000) 000-0000.
  • Should be Empty: