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 signed Declaration of U.S. Citizenship or Lawful Presence of an Alien
- A legible photocopy or digital copy of a document demonstrating U.S. citizenship or lawful presence in the U.S.
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 Information Release Form 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). This form is fillable and should be typewritten, not handwritten.
- 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.
- Critical Care Paramedic Application - Complete this application in addition to your individual license application to acquire the critical care endorsement. This form is fillable and should be typewritten, not handwritten.
- 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.
- The OEMS has established a license denial policy based on Section 22-18-6(f) of the Code of Alabama.
- An individual who checks Yes to having a diagnosed condition that may affect their ability to safely practice must have a physician complete the Essential Job Functions Analysis Form and submit it with their application. The individual must be re-evaluated with any change in the condition.
- An individual who checks Yes to having a conviction must supply documentation as to the nature of the offense, the current status and disposition of the case, and a personal statement concerning the incident(s) in question. Please provide a separate statement and documentation for each conviction.
- According to Rule 420-2-1-.08, any changes to an individual's name or contact information must be reported to the OEMS within 10 days of the change. Please use the Information Update Form to submit these changes. Name changes must be accompanied by official documentation such as a marriage license or driver's license.
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.
Critical Care Provider Application - Complete this application and submit it with the provider license application to acquire the critical care endorsement.
The following plans are required to be included with your EMS Provider licensure application.
Effective August 1, 2016, Air or Ground Provider Licensure fees will increase to $30 for a 12-month license as required by new legislation.
Coordinated Deployment MOU
If your service will be involved in coordinated deployment, please complete the MOU for your region. All blanks must be filled in and the document returned to the OEMS with an original signature.
Medical Needs Shelter MOU
If your service will be established as a medical needs shelter, please complete the MOU for your region. All blanks must be filled in and the document returned to the OEMS with an original signature.
Page last updated: January 24, 2019