"Application for Reinstatement or Re-entry" - Idaho

Application for Reinstatement or Re-entry is a legal document that was released by the Idaho State Board of Accountancy - a government authority operating within Idaho.

Form Details:

  • Released on September 1, 2021;
  • The latest edition currently provided by the Idaho State Board of Accountancy;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Idaho State Board of Accountancy.

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For Office Use Only
Division of Occupational
Board of Accountancy
Batch
_________________
and Professional Licenses
PO Box 83720
11351 W Chinden Bldg #6
Boise ID 83720-0002
Sequence #
_________________
Boise, ID 83714
(208) 334-2490
208-334-3233
E-Mail: isba@isba.idaho.gov
Date
_________________
Website: dopl.idaho.gov
Website: isba.idaho.gov
Check #
_________________
APPLICATION FOR REINSTATEMENT or RE-ENTRY
Lapsed or Suspended licenses may be Reinstated. Inactive or Retired licensees may request
Amount
_________________
Re-Entry. Complete this application, attach documentation of 80 hours of CPE (4 of which must
be ethics with at least 2 Idaho specific ethics), and pay the non-refundable Reinstatement or
Re-Entry fee. Contact the office for fee amount.
License #
First Name
Middle Name
Last Name
Suffix
DOB
Home Phone
Cell Phone
Work Phone
Email Address
Mailing Address
Alternate Address
In Care of: __________________________________________
In Care of: _______________________________________
Street 1: ___________________________________________
Street 1: _________________________________________
Street 2: ___________________________________________
Street 2: _________________________________________
City, State, Zip: ______________________________________
City, State, Zip: ____________________________________
While your license was Lapsed, Suspended, Inactive or Retired, did you:
YES
NO
Sign Financial Reports as a CPA/LPA?
YES
NO
Sign Tax Returns as a CPA/LPA?
YES
NO
Practice Public Accounting in any other manner?
YES
NO
Use the CPA/LPA title in any manner?
YES
NO
Use stationery or business cards as a CPA/LPA?
YES
NO
Will you or your firm be providing public accounting services in Idaho or for Idahoans?
If Yes: Firm Name _____________________________________________
Address ________________________________________________
City, State, Zip ___________________________________________
Peer Reviewed Services Offered:
______Audits
______Reviews
______Compilations
Non-Peer Reviewed Services Offered:
______Taxes
______Consulting
______Financial Statements using Safe Harbor language
Safe Harbor statements cannot be prepared if your firm does audits, compilations or reviews for any clients. Tax and/or consulting may be
included with Peer Review or Non-Peer Review services.
DATE CPE HOURS BEGAN ______________________________DATE CPE HOURS COMPLETED_____________________________
CPE must be completed during the twelve-month period immediately prior to the application submission date. i.e. An application submitted
August 1, 2021 requires that CPE be completed between August 1, 2020 and July 31, 2021.
YES
NO
Are you or your spouse an active member or honorably discharged veteran of the United States Armed Services?
If yes, attach a copy of your DD-214 form, you are entitled to certain benefits because of your service.
YES
NO
Have you been charged with; pleaded guilty, no contest or nolo contendere to; been convicted or found guilty of; or
been sentenced for any felony or misdemeanor to this Board in writing? Not previously disclosed. (Include traffic violations if felony or mis-
demeanor, but not infractions, such as speeding tickets.) If yes, provide factual description including date, court involved, disposition of
case, whether disposition has been fully satisfied, and name and address of the office in possession of the record of the event.
YES
NO
Have you had an application for license denied, restricted, suspended or revoked by any state or federal agency or gov-
erning or licensing board? Not previously disclosed. If yes, please provide explanation.
Statements of this application are true and correct to the best of my knowledge and belief and are made under penalty of perjury.
Date __________________________ Signature _________________________________________________
FOR OFFICE USE ONLY: ID Courts
Record
No Record
Date ----------------------
Initials -----------------------
Revised 9/2021
For Office Use Only
Division of Occupational
Board of Accountancy
Batch
_________________
and Professional Licenses
PO Box 83720
11351 W Chinden Bldg #6
Boise ID 83720-0002
Sequence #
_________________
Boise, ID 83714
(208) 334-2490
208-334-3233
E-Mail: isba@isba.idaho.gov
Date
_________________
Website: dopl.idaho.gov
Website: isba.idaho.gov
Check #
_________________
APPLICATION FOR REINSTATEMENT or RE-ENTRY
Lapsed or Suspended licenses may be Reinstated. Inactive or Retired licensees may request
Amount
_________________
Re-Entry. Complete this application, attach documentation of 80 hours of CPE (4 of which must
be ethics with at least 2 Idaho specific ethics), and pay the non-refundable Reinstatement or
Re-Entry fee. Contact the office for fee amount.
License #
First Name
Middle Name
Last Name
Suffix
DOB
Home Phone
Cell Phone
Work Phone
Email Address
Mailing Address
Alternate Address
In Care of: __________________________________________
In Care of: _______________________________________
Street 1: ___________________________________________
Street 1: _________________________________________
Street 2: ___________________________________________
Street 2: _________________________________________
City, State, Zip: ______________________________________
City, State, Zip: ____________________________________
While your license was Lapsed, Suspended, Inactive or Retired, did you:
YES
NO
Sign Financial Reports as a CPA/LPA?
YES
NO
Sign Tax Returns as a CPA/LPA?
YES
NO
Practice Public Accounting in any other manner?
YES
NO
Use the CPA/LPA title in any manner?
YES
NO
Use stationery or business cards as a CPA/LPA?
YES
NO
Will you or your firm be providing public accounting services in Idaho or for Idahoans?
If Yes: Firm Name _____________________________________________
Address ________________________________________________
City, State, Zip ___________________________________________
Peer Reviewed Services Offered:
______Audits
______Reviews
______Compilations
Non-Peer Reviewed Services Offered:
______Taxes
______Consulting
______Financial Statements using Safe Harbor language
Safe Harbor statements cannot be prepared if your firm does audits, compilations or reviews for any clients. Tax and/or consulting may be
included with Peer Review or Non-Peer Review services.
DATE CPE HOURS BEGAN ______________________________DATE CPE HOURS COMPLETED_____________________________
CPE must be completed during the twelve-month period immediately prior to the application submission date. i.e. An application submitted
August 1, 2021 requires that CPE be completed between August 1, 2020 and July 31, 2021.
YES
NO
Are you or your spouse an active member or honorably discharged veteran of the United States Armed Services?
If yes, attach a copy of your DD-214 form, you are entitled to certain benefits because of your service.
YES
NO
Have you been charged with; pleaded guilty, no contest or nolo contendere to; been convicted or found guilty of; or
been sentenced for any felony or misdemeanor to this Board in writing? Not previously disclosed. (Include traffic violations if felony or mis-
demeanor, but not infractions, such as speeding tickets.) If yes, provide factual description including date, court involved, disposition of
case, whether disposition has been fully satisfied, and name and address of the office in possession of the record of the event.
YES
NO
Have you had an application for license denied, restricted, suspended or revoked by any state or federal agency or gov-
erning or licensing board? Not previously disclosed. If yes, please provide explanation.
Statements of this application are true and correct to the best of my knowledge and belief and are made under penalty of perjury.
Date __________________________ Signature _________________________________________________
FOR OFFICE USE ONLY: ID Courts
Record
No Record
Date ----------------------
Initials -----------------------
Revised 9/2021
Board of Accountancy
License #
Reinstatement or Re-Entry CPE Report
List courses completed one year prior to the date the application is completed to fulfill the requirement of 80 CPE
hours, including 4 ethics of which 2 must be Idaho state specific. Attach copies of each certificate along with this form.
DELIVERY
PROGRAM
ETHICS
TOTAL
METHOD
SPONSOR
HOURS
HOURS
DATES
TITLE OF PROGRAM
HOURS
1/26/2021 See Below
Tax Update
ISCPA
6
2
8
Example
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TOTALS
Delivery Methods: Group, Self-Study, Nano, University/College course, Blended
Attach copies of each certificate along with this form.
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