Form Ars - Application For Retired Status - California Board Of Occupational Therapy Page 2
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24. CERTIFICATION/AGREEMENT
I certify under penalty of perjury under the laws of the State of California that the foregoing is
true and correct, and I agree with the terms and conditions of this request.
__________________________________________
____________________
Signature of License Holder
Date
Processing time to receive a new pocket license is approximately 2-3 weeks after the Board updates your license. You may verify on the
Board’s website if your license has been updated.
5. ACTIVATION PROCESS
In accordance with section 4128(f) in order to restore the license to active status you have to:
a) complete the form “Request for Activation of License on Retired Status” ;
b) pay the biennial renewal fee in effect at the time the request for activation is received;
c) complete 24 PDUs within two (2) years of the date the application for reactivation is
received, or if the license is in retired status for period of five (5) years complete 40 PDUs as
specified in section 4161(g).
Note: A license in retired status can be issued no more than two times!
If you have questions, please refer to the Board’s website
or contact the Board
at (916) 263-2294.
Form ARS
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