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NICE Annual Compliance "Reachback Hours" Report Form

Reachback Report Form
  • pdf version
  • doc version
  • Use this form only if you fall short of the required 15 CE Hours.

    The credit hours you report for the current reporting period may include up to 3 hours from the prior reporting period (you may only go back 1 year). You may "reach back" and use up to 3 excess hours from the prior year — that is, 3 hours that were not previously used. Fill out this form and the detailed ssection page, listing your "reach back" hours as you would any other credit hour.

    This form must be submitted in addition to your regular NICE Annual Compliance Report Form.

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