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The Minnesota R-20 form plays a critical role in shaping the professional journey of aspiring Qualified Rehabilitation Consultant Interns within the state, serving as the foundational step for those entering the field of rehabilitation and workers' compensation. Administered by the Minnesota Department of Labor and Industry, this vital document outlines the application process for approval and registration, ensuring that candidates meet the stringent requirements set forth by the state. Prospective applicants are required to submit personal data, including their educational background, professional licensure, and language skills, together with a fee, underlining the comprehensiveness of the review process. Furthermore, applicants must delineate their employment history in detail, providing a blueprint of their practical experience and readiness for the role. This meticulous approach not only establishes a high standard of competence among rehabilitation consultants but also underscores Minnesota's commitment to supporting workers through qualified and well-prepared professionals. With provisions for supervisory plans and accessibility options for differently-abled individuals, the form reflects an inclusive and thorough process designed to foster a capable and diverse cohort of rehabilitation consultants ready to contribute to the state’s labor industry.

Minnesota R 20 Example

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

CITY

STATE ZIP CODE

 

 

 

 

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.

Yes

No

5. Are you able to communicate with the deaf in sign language?

Yes

No

6. Have you applied for registration as a QRC/Intern or a Registered Rehabilitation Vendor in Minnesota in the past?

Yes

No

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)

 

 

 

 

 

 

CITY

STATE

ZIP CODE

JOB TITLE

 

 

 

 

 

 

Duties:

 

 

 

 

 

 

 

 

 

EMPLOYER NAME

 

 

PHONE NUMBER

IMMEDIATE SUPERVISOR NAME

 

 

 

 

 

ADDRESS

 

 

DATES (from and to)

 

 

 

 

 

 

CITY

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

DATE

NOTARY FOR SUPERVISOR

MY COMMISSION EXPIRES

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.

Form Characteristics

Fact Detail
Purpose of Form R-20 For individuals seeking approval and registration as a Qualified Rehabilitation Consultant Intern in Minnesota.
Application Fee Includes a check or money order for $110.00 payable to the Commissioner of the Department of Labor and Industry, reflecting a 10% surcharge as mandated by 2009 Laws, Chapter 101, Article 2, Section 59.
Professional Requirements Applicants must provide proof of professional licensure, certification, or registration if available.
Supervision Requirement Applicants must name a Qualified Rehabilitation Consultant (QRC) under whose supervision they will work and attach a plan of supervision as per Minn. Rules 5220.1400, subp. 3a.
Educational and Employment History Applicants are required to attach official transcripts of all postsecondary education and provide detailed descriptions of their work history.
Governing Laws and Regulations The process and requirements are guided by Minnesota Rules 5220.1400, subparts 3a and 5, and other relevant statutes, rules, and orders related to Workers’ Compensation and rehabilitation consulting in Minnesota.

Steps to Writing Minnesota R 20

Filling out the Minnesota R-20 form is imperative for those seeking approval and registration as a Qualified Rehabilitation Consultant Intern. This step-by-step guide will ensure the process is done correctly, ensuring all personal, education, and employment data are accurately provided. Once completed, this form allows the Department of Labor and Industry to assess qualifications for potential registration, marking the beginning of a new phase in professional development. All steps should be followed closely to avoid any potential delays or the need for resubmission.

  1. Start by entering your full name (last, first, middle) in the designated space at the top of the form.
  2. Fill out your residential address, including city, state, and zip code.
  3. Provide the name of the prospective employer along with their address, city, state, and zip code under the "Employer Address" section.
  4. Include your home phone number and business phone number in the relevant fields.
  5. Answer the question regarding your professional licensure, certification, or registration. If you answer "Yes," attach a copy of the relevant documents.
  6. Enter the name of the Qualified Rehabilitation Consultant (QRC) under whose supervision you will be working.
  7. Enclose the required fee of $110.00 with the form. Ensure the check or money order is payable to the Commissioner of the Department of Labor and Industry.
  8. Specify if you speak or write any foreign language, including the name of the language and the number of years of experience.
  9. Indicate your ability to communicate with the deaf using sign language.
  10. Detail any previous applications for registration as a QRC/Intern or a Registered Rehabilitation Vendor in Minnesota, including dates if applicable.
  11. Under the Education Data section, attach official transcripts of all relevant postsecondary education and list any continuing education pertinent to this registration.
  12. For your employment history, describe in detail your current or most recent job, including employer name, phone number, supervisor's name, address, job title, and duties. Attach additional sheets if necessary.
  13. List any honors, peer recognition, or other information that may be relevant to your registration.
  14. Read and understand the authorization statement at the end of the form, regarding the investigation of your application and supporting documents, then sign and date the form.
  15. Ensure the NOTARY FOR APPLICANT section is completed, with the My Commission Expires field filled out.
  16. Have your supervisor agree to provide the supervision outlined, sign, and date the section titled NOT< NOTARY FOR SUPERVISOR
  17. and complete the My Commission Expires field.

After fulfilling these steps, double-check the form for completeness and accuracy. Submitting accurate and comprehensive information will facilitate a smoother evaluation process. Submit all application documents, along with the specified fee, to the address provided on the form. It's essential to keep copies of the submitted form and attachments for your records.

Listed Questions and Answers

  1. What is the purpose of the Minnesota R-20 form?

    The Minnesota R-20 form is an application used by individuals seeking approval and registration as Qualified Rehabilitation Consultant Interns (QRC Interns) in Minnesota. Its main purpose is to collect necessary personal, professional, and educational information from applicants to ensure they meet the qualifications for the role. This includes details on professional licensure, education, and employment history.

  2. Who needs to fill out the Minnesota R-20 form?

    Individuals aspiring to become QRC Interns in Minnesota, under the supervision of a Qualified Rehabilitation Consultant, must fill out the R-20 form. This is a necessary step for those entering the field of vocational rehabilitation, specifically within the workers' compensation system, to assist employees in their recovery and return to work.

  3. What documents are required to accompany the R-20 form?

    Applicants must include several key documents along with their R-20 form:

    • A copy of any professional license, certification, or registration if applicable.
    • Official transcripts of all postsecondary education.
    • A plan of supervision from the QRC under whose guidance the intern will work, addressing the requirements outlined in Minn. Rules 5220.1400, subp. 3a.
    • A detailed work history and any additional pertinent information, such as honors or peer recognition, on a separate sheet if necessary.
  4. Is there a fee to submit the R-20 form, and how should it be paid?

    Yes, there is a fee of $110.00 to submit the R-20 form. This fee includes a 10% surcharge as per the 2009 Laws, Chapter 101, Article 2, Section 59. Payments should be made via check or money order payable to the Commissioner of the Department of Labor and Industry.

  5. Can non-Minnesota residents apply using the R-20 form?

    Yes, non-Minnesota residents can apply, but there is a specific requirement. Applicants must either be a full-time resident of Minnesota or live no more than 100 miles by road from the Minnesota border. This ensures that the applicants are readily available for supervision and engagement in the local workers' compensation rehabilitation process.

  6. How does one submit the completed R-20 form and accompanying documents?

    All application documents, including the R-20 form and additional required paperwork, should be sent to the Minnesota Department of Labor and Industry's Financial Services section at the address provided on the form. It's important to check that all information is complete and accurate before submission to avoid delays in the registration process.

  7. What happens after submitting the R-20 form?

    After submission, the application will undergo a review process by the Workers’ Compensation Division of the Department of Labor and Industry. The applicant might be contacted for further information or clarification. If the application is approved, the applicant will receive a registration as a Qualified Rehabilitation Consultant Intern, allowing them to begin supervised work in the field.

  8. What are the responsibilities of a Qualified Rehabilitation Consultant Intern after approval?

    Upon approval, QRC Interns have several responsibilities, including:

    • Adhering to all statutes, rules, and orders relevant to their role.
    • Notifying the Workers’ Compensation Division of any change in employment status.
    • Ensuring that all parties involved in a case are informed of any reassignment, subject to the approval of the Commissioner of Labor and Industry.

    These responsibilities ensure that the intern conducts themselves professionally and in accordance with the regulations governing their field.

Common mistakes

Filling out the Minnesota R-20 form is an essential step for those seeking approval and registration as a Qualified Rehabilitation Consultant Intern. However, applicants often make several common errors during this process:

  1. Not reading instructions carefully: Skipping the detailed instructions provided can lead to misunderstandings about what is required, resulting in incomplete applications.
  2. Failing to print or type: The form specifies that applicants should PRINT or TYPE the information. Handwritten forms that are hard to read can cause processing delays.
  3. Omitting professional license or certification details: Some applicants forget to list their licensure, certifications, or registrations, or fail to attach copies of these credentials as instructed.
  4. Incomplete education history: Leaving out pertinent postsecondary education data or forgetting to attach official transcripts can make the application void or delay its processing.
  5. Not specifying a supervisor: Applicants must name the Qualified Rehabilitation Consultant under whose supervision they will work. Failing to do so can be a significant oversight.
  6. Incorrect fee payment: The form requires a specific fee, payable by check or money order. Applicants sometimes forget to include the fee or make it out to the wrong entity.
  7. Overlooking language skills: Failing to mention the ability to speak or write in a foreign language or to communicate using sign language can neglect to showcase valuable skills that might enhance the application.
  8. Leaving the employment history section incomplete: Applicants often provide inadequate detail about their work history or forget to attach additional sheets when the space provided is insufficient.

Avoiding these common mistakes can streamline the approval process, ensuring that applicants present their qualifications and intentions accurately and completely.

Documents used along the form

The Minnesota R-20 form is crucial for professionals aspiring to become Qualified Rehabilitation Consultant Interns in Minnesota. Alongside this form, several other documents and forms are often required to ensure the completeness and compliance of the application package. These documents play a pivotal role in illustrating the applicant's qualifications, experience, and legal compliance.

  • Official Transcripts: Represents the applicant’s academic achievements by providing a detailed record of courses taken and grades received, usually required to verify the level of education claimed on the R-20 application.
  • Plan of Supervision: A document that outlines how the QRC supervisor intends to oversee the intern's work, ensuring that it meets the standards set by the Minnesota Department of Labor and Industry.
  • Copy of Professional License/Certification: Proof of any relevant professional licensure or certification that supports the applicant’s qualifications in the field of rehabilitation consulting.
  • Continuing Education Records: Documentations detailing any relevant continuing education courses or programs the applicant has completed in the last two months, emphasizing their commitment to staying informed about the latest developments in their field.
  • Employment Verification Letter: A letter from an employer that confirms the applicant’s job title, responsibilities, and tenure, providing a real-world context for their professional experience.
  • Background Check Authorization: A form that permits the Minnesota Department of Labor and Industry to conduct a background check to verify the information provided in the application and ensure the applicant's clean legal record.
  • Notarized Statements: Official statements made by the applicant and their supervising QRC, validated by a notary to affirm the authenticity of their signatures and the truths of the claims made in the application.
  • Proof of Residence: Documentation verifying that the applicant lives within Minnesota or within 100 miles of its border, in compliance with the state's regulations for applicants.

Together, these documents form a comprehensive dossier that supports the R-20 form, illustrating the applicant’s readiness and suitability to undertake the role of a Qualified Rehabilitation Consultant Intern in Minnesota. They provide essential context and evidence that help the Department of Labor and Industry to assess the application thoroughly and fairly.

Similar forms

The Minnesota R 20 form, essential for aspiring Qualified Rehabilitation Consultant Interns, mirrors the Professional Engineer (PE) licensure application in several ways. Both forms necessitate personal data, professional licensure, and detailed education and employment history. Applicants for either designation are required to disclose any past applications within their respective fields. These documents ensure that candidates possess the necessary credentials and experience to maintain high standards within their professions.

Similar to the Minnesota R 20 form, the Certified Public Accountant (CPA) license application also demands comprehensive information from applicants. This includes personal data, proof of education, detailed employment history, and any prior certification attempts. Both forms serve to verify the applicant’s qualifications and adherence to the professional standards and regulatory requirements of their respective fields, emphasizing the integrity of these professions.

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) application shares similarities with the R 20 form in requiring detailed personal information, educational background, and licensure details. Both forms scrutinize the applicant’s readiness and eligibility to ensure that only qualified individuals are allowed to enter these vital health and rehabilitation professions, safeguarding public welfare.

The application for becoming a Licensed Clinical Social Worker (LCSW) parallels the structure of the Minnesota R 20 form by collecting extensive personal, educational, and professional information. Each application demands evidence of supervision and adherence to regulatory requirements, ensuring candidates are well-prepared and ethical in their practice, mirroring the overall objective of fostering competent professionals across fields.

The Bar Examination application for lawyers, much like the R 20, asks for detailed personal, educational, and professional history, including any past examinations and licensures. Both applications undertake a meticulous review process, highlighting the importance of integrity, competence, and accountability in professions with significant societal impact.

The application for a real estate license is akin to the R 20 form in several aspects. It compiles comprehensive personal information, work history, and educational background. Real estate candidates, similar to rehabilitation consultant interns, must meet specific educational prerequisites and demonstrate their readiness for professional responsibilities, underscoring the commitment to industry standards and consumer protection.

Finally, the Certified Health Education Specialist (CHES) certification process echoes the demands of the Minnesota R 20 form by requiring detailed personal information, academic transcripts, and proof of professional competencies. Both the CHES certification and the R 20 form aim to ascertain the applicant's dedication to their professional development and their competence to serve the public effectively.

Dos and Don'ts

Filling out the Minnesota R-20 Application for Approval and Registration Qualified Rehabilitation Consultant Intern requires your careful attention to detail and accuracy. Here's a guide on what you should and shouldn't do to ensure your application is complete and stands the best chance of being approved.

  • Do carefully read all instructions before you begin filling out the form to ensure you understand each requirement.
  • Do print or type your information clearly to prevent any misinterpretation or errors in processing your application.
  • Do attach a check or money order for the correct amount as specified in the instructions to avoid any delay in processing.
  • Do provide official transcripts of all pertinent postsecondary education to substantiate your educational background.
  • Do attach a copy of any license/certification/registration if you are currently holding a professional licensure, certification or registration.
  • Don't leave any sections incomplete unless they are explicitly stated as optional. Incomplete applications may result in delayed processing or denial.
  • Don't forget to sign and date the application form. An unsigned application is considered incomplete.
  • Don't send without double-checking all the information provided for accuracy and completeness.
  • Don't hesitate to include additional sheets if needed, especially when describing your employment history in detail, but make sure they are clearly labeled and attached securely to your application.

Following these dos and don'ts will help ensure your application process goes smoothly and increases the likelihood of a positive outcome. Remember, accuracy, completeness, and following instructions are key to a successful application. to a UIViewController in Swift

Misconceptions

When navigating the complexities of regulatory forms required for professionals in Minnesota, the R-20 Application for Approval and Registration of a Qualified Rehabilitation Consultant Intern can often be misunderstood. Let's demystify some common misconceptions surrounding this important document.

  • Misconception 1: The R-20 form is only for new graduates.
  • Actually, the R-20 form is not exclusively for recent graduates. It is intended for any individual seeking approval and registration as a Qualified Rehabilitation Consultant Intern in Minnesota, regardless of when they completed their education. This includes professionals transitioning from different fields or states.

  • Misconception 2: You don't need to submit educational transcripts with the R-20 form.
  • This is incorrect. The application process requires the attachment of official transcripts of all pertinent postsecondary education. This documentation is crucial for verifying the educational qualifications of the applicant.

  • Misconception 3: Language skills are not considered important in the application.
  • On the contrary, the form explicitly inquires about the applicant's ability to speak or write any foreign languages, including the ability to communicate using sign language. These skills can be critical in a rehabilitation setting where communication with diverse populations is necessary.

  • Misconception 4: Professional licensure, certification, or registration details are optional.
  • This is not the case. The form asks if the applicant holds any professional licensure, certification, or registration and requires the applicant to attach a copy of any license, certification, or registration. This information is key in assessing the qualifications and legal standing of the candidate within their profession.

  • Misconception 5: The application process is complete once the form is submitted.
  • Filing the R-20 form is only a step in the application process. Applicants must also ensure they include the necessary supervisory plan and any additional requested documents. Plus, they must be prepared for further communication from the Department of Labor and Industry, which may include requests for additional information or clarification.

  • Misconception 6: You do not need to notify the Department of Labor and Industry regarding changes in employment status after submitting the R-20 form.
  • In reality, the applicant agrees to notify the Workers’ Compensation Division of any change in employment status post-approval. This is crucial for maintaining accurate records and ensuring compliance with all regulatory requirements.

Understanding these nuances surrounding the R-20 form can significantly streamline the application process for becoming a Qualified Rehabilitation Consultant Intern in Minnesota. It is essential to read instructions carefully, provide all requested documentation, and maintain open lines of communication with the Department of Labor and Industry.

Key takeaways

When filling out the Minnesota R-20 form, which is the Application for Approval and Registration of a Qualified Rehabilitation Consultant Intern, there are several key steps and details applicants must be aware of to ensure the process is completed successfully and efficiently. Here are five key takeaways from the R-20 form instructions and requirements:

  • All applicants need to provide personal data, including their name, address, prospective employer information, and contact details. It's critical that this information is printed or typed clearly to avoid any confusion or delays in the application process.
  • Applicants must indicate whether they hold any professional licensure, certification, or registration relevant to the role of a Qualified Rehabilitation Consultant Intern. If applicable, copies of such documents should be attached to the R-20 form. This step is essential for the Department of Labor and Industry to verify the applicant's qualifications.
  • A fee of $110.00, which includes a 10% surcharge as per the 2009 Laws, Chapter 101, Article 2, Section 59, must be enclosed with the application. Payments should be made via check or money order payable to the Commissioner of the Department of Labor and Industry. This fee covers the administrative costs of processing the application.
  • The application requires information about the applicant's education history, including official transcripts of all postsecondary education. It is also necessary to attach a list of continuing education completed within the past 2 months that pertains to the registration. This part of the application helps assess the applicant's readiness and eligibility for the intern role.
  • Supervision plans are a crucial component of the application. Applicants must have a Qualified Rehabilitation Consultant (QRC) supervisor and include a detailed plan of supervision that addresses all requirements as per Minn. Rules 5220.1400, subp. 3a. This ensures that the intern will receive proper guidance and support throughout their internship.

In conclusion, filling out the Minnesota R-20 form requires careful attention to detail and thorough preparation. Applicants must ensure all sections are completed accurately, provide all necessary documentation, and comply with the specified requirements. By following these guidelines, individuals can streamline their application process for becoming a Qualified Rehabilitation Consultant Intern in Minnesota.

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