Verification of Completion of Required Clinical Hours (HA5)

Please complete and submit the HA5 here. This form is mainly for HAD-LLs (Hearing-Aid Dispensers limited licensees).


If you are not an HAD-LL, please double check the form and the submission link you are using.


The limited licensee must submit the Form HA5 to the Board when the licensee has completed the required 6 months of clinical training with 20 consecutive days engaging in the practice of fitting and dispensing hearing aids while under at least 20 hours per month of direct supervision.


HA5 Form

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