INSTRUCTION SHEET PHARMACY TECHNICIAN

PACKET UPDATED 7/16/24

INSTRUCTION SHEET

PHARMACY TECHNICIAN

Reinstatement

DPR-PHARMACY TECH REINSTATEMENT 7/24

Step I - Application and Supporting Documents.

1. If the Pharmacy Technician license is already CERTIFIED, submit the following:

a. A completed APPLICATION FOR REINSTATEMENT.

b. Documentation of any name changes during the period the license was not INACTIVE or NOT RENEWED.

One must document each step of each change. Acceptable forms of proof include divorce decrees, spouse’s

death certiﬁ cates, court orders showing name change, marriage certiﬁ cates, naturalization documents.

Documents that are not acceptable include driver’s licenses, passports, and social security cards.

c. Evidence of completing the Continuing Education requirements of Rules 68 IAC Section 1330.230 and

Rules 68 IAC Section 1130.Subpart E (10 hours of CE including at least one hour in each):

 pharmacy law (Act 225 ILCS 85/9.5)

patient safety (Act 225 ILCS 85/9.5)

 sexual harassment prevention (Rules 68 IAC Section 1130.400)

 implicit bias awareness (Rules 68 IAC Section 1130.500)

2. If the Pharmacy Technician license was issued prior to January 1, 2008, OR If the Pharmacy Technician license was

issued less than 2 years ago, OR If the Pharmacy Technician license is a STUDENT PHARMACIST license, submit:

a. A completed APPLICATION FOR REINSTATEMENT.

b. Documentation of any name changes during the period the license was not INACTIVE or NOT RENEWED.

One must document each step of each change. Acceptable forms of proof include divorce decrees, spouse’s

death certiﬁ cates, court orders showing name change, marriage certiﬁ cates, naturalization documents.

Documents that are not acceptable include driver’s licenses, passports, and social security cards.

For your application to be processed,

ALL REQUIRED SUPPORTING DOCUMENTATION MUST BE SUBMITTED

with the application and required fee unless otherwise directed in the instructions.

There are three ways to reinstate your pharmacy technician license:

STEP II - Fee

STEP III - Mail Application

Need Assistance

Identify the fee to reinstatement your license by using the Restoration/Reinstatement

Fee Calculator.

Payment must be in the form of a check or money order payable to IDFPR, or by

submitting a payment online using the ePay Portal at:

https://idfpr.illinois.gov/epay.html

Mail your application for reinstatement, supporting documents and payment to:

Illinois Department of Financial and Professional Regulation

ATTN: Division of Professional Regulation

PO Box 7450

Springﬁ eld, IL 62791

If you need assistance, please contact the Department of Financial and Professional

Regulation at:

1-800-560-6420 TTY: 1-866-325-4949

Pharmacy Technician Restoration - Page 2

3. If the Pharmacy Technician license is a STUDENT PHARMACIST license, OR All other licenses, OR If one is

not sure, submit:

a. A completed APPLICATION FOR REINSTATEMENT.

b. Documentation of any name changes during the period the license was not INACTIVE or NOT RENEWED.

One must document each step of each change. Acceptable forms of proof include divorce decrees, spouse’s

death certiﬁ cates, court orders showing name change, marriage certiﬁ cates, naturalization documents.

Documents that are not acceptable include driver’s licenses, passports, and social security cards.

c. Evidence of being CERTIFIED or STUDENT PHARMACIST. Being CERTIFIED involves two things-

EDUCATION and EXAMINATION

 For the EXAMINATION, one must pass either the ExCPT or PTCB

Pharmacy Technician Certiﬁ cation Exam and provide in a copy of the certiﬁ cate.

 For EDUCATION, one can complete a Pharmacy Technician

Certiﬁ cation diploma program, or one could have a pharmacist

report that they have completed on the job training. One can use the form at

https://idfpr.illinois.gov/content/dam/soi/en/web/idfpr/renewals/apply/forms/f2224.pdf

for on-the-job training.

 The same form may be used to document STUDENT status.

IL486-2536 7/24

Check the box indicating the appropriate information regarding your application.

Military Military Spouse Not Military Decline to Answer

Military service member is deﬁ ned as. “Service member means any person who, at the time of application under this Section, is an active duty member of

the United States Armed Forces or any reserve component of the United States Armed Forces, the Coast Guard, or the National Guard of any state,

commonwealth, or territory of the United States or the District of Columbia or whose active duty service concluded within the preceding 2 years before

application.” The following will be considered proof of you or your spouse’s active military status: DD214, Letter of Service signed by Unit Commanding

Oﬃ cer, or Proof of Service document from the Servicemember's electronic personnel portal. Proof for Spouses: Military Permanent Change of Station

Orders with the spouse identiﬁ ed by name; Oﬃ cial Notiﬁ cation of Change of Assignment with your marriage license, a certiﬁ ed DD1172 verifying marital

status, or a letter signed by the commanding oﬃ cer verifying change of assignment and the name of the military spouse.

Illinois Department of Financial and Professional Regulation

Division of Professional Regulation

Request for Reinstatement of Illinois License

PLEASE PRINT

License No:_____________________ SSN or ITIN:_________________ Date of Birth:____________________

(last four only)

First Name:________________________________ Last Name:______________________________________

Business Name:__________________________________________________ FEIN #:___________________

Address:__________________________________________________________________________________

City:________________________________________ State:____________________ Zip:________________

Phone Number:__________________________ Email Address:______________________________________

CHECK HERE IF NAME OR ADDRESS CHANGE.

A name change must be accompanied by documentary proof. Proof

must be a certiﬁ ed copy with an oﬃ cial stamp or seal and be one of the following: Marriage Certiﬁ cate, Divorce Decree or Court Order.

I consent to professional organizations having my email address.

1. In accordance with 5 Illinois Compiled Statutes 100/10-65(c), applications for renewal of a license or a new license shall include the applicant's

Social Security number, and the licensee shall certify, under penalty of perjury, that he or she is not more than 30 days delinquent in complying

with a child support order. Failure to certify shall result in disciplinary action, and making a false statement may subject the licensee to

contempt of court.

Are you more than 30 days delinquent in complying with a child support order? Yes No

(NOTE: If you are not subject to a child support order, answer "no.")

2. In accordance with 20 ILCS 2105-15(g), "The Department shall deny any license application or renewal authorized under any licensing Act

administered by the Department to any person who has failed to ﬁ le a return, or to pay the tax, penalty, or interest shown in a ﬁ led return, or to

pay any ﬁ nal assessment of tax, penalty, or interest, as required by any tax Act administered by the Illinois Department of Revenue, until such

time as the requirement of any such tax Act is satisﬁ ed."

Are you delinquent in the ﬁ ling of state taxes? Yes No

3. In accordance with 20 ILCS 2105/2105-15(g-5), “The Department shall refuse the issuance or renewal of a license to, or suspend or revoke

the license of, any individual, corporation, partnership, or other business entity that has been found by the Illinois Workers' Compensation

Commission or the Department of Insurance to have failed to secure workers' compensation obligations, or pay in full a ﬁ ne or penalty imposed

due to a failure to secure workers' compensation obligations.”

Are you delinquent in complying with workers’ compensation obligations Yes No

4. Do you certify you have fully complied with this profession’s continuing education requirements? Yes No

NOTE: Continuing education is not required for the ﬁ rst renewal of this license. If this is your ﬁ rst renewal, please answer (Yes) to this question.

Making a false statement may subject the licensee to disciplinary action.

You may verify the continuing education requirements of your profession here: https://idfpr.illinois.gov/rules2015.html

IL486-2536

Pursuant to 20 ILCS 2105-165(a), the Department requires the following professionals to disclose information regarding charges or

convictions pertaining to certain oﬀ enses. Please check applicable profession.

Advanced Practice Registered Nurse

Acupuncturist

Audiologist

Dental Hygienist

Sex Oﬀ ender Evaluator

Dentist

Athletic Trainer

Genetic Counselor

Marriage and Family Therapist

Sex Oﬀ ender Associate

Licensed Practical Nurse

Psychologist, Clinical (LCP)

Professional Counselor, Clinical

(LCPC)

Registered Nurse

Sex Oﬀ ender Treatment Provider

Respiratory Care Practitioner

Podiatrist

Registered Surgical Assistant

Registered Surgical Technologist

Prosthetist

Advanced Practice Registered

Nurse - Full Practice Authority

Behavior Analyst

Behavior Analyst Assistant

Certiﬁ ed Midwife

Chiropractic Physicians (D.C.)

Professional Counselor (LPC)

Physician Assistant

Occupational Therapist

Occupational Therapy Assistant

Naprapath

Pharmacist

Physical Therapist

Physicians, including Medical

Doctors (M.D.), Doctors of

Osteopathic Medicine (D.O.)

Physical Therapy Assistant

Nursing Home Administrator

Orthotist

Pedorthist

Optometrist

Perfusionist

Social Worker, Clinical (LCSW)

Social Worker (LSW)

Speech Pathologist

Any other license issued by the Department under the Acts listed in this Section and the Controlled Substances Act [740 ILCS 40], except for pharmacy

technicians, issued to a person subject to the Code and this Part.

Marriage and Family Therapist Assoc.

Music Therapist

If you selected a profession above, please complete the next 4 questions.

If YES to any of the above, attach a personal statement describing the circumstances of the charge or conviction and a

certiﬁ ed copy of the court records regarding your charge or conviction, including the nature of the oﬀ ense and date of

discharge, if applicable, as well as a statement from the probation or parole oﬃ ce.

Are you required, as part of a criminal sentence, to register under the Sex Oﬀ ender Registration Act? *

Are you currently charged with or have you been convicted of a criminal battery against any patient in the

course of patient care or treatment, including any oﬀ ense based on sexual conduct or sexual penetration?

Yes

Are you currently charged with or have you been convicted of a criminal act that requires registration

under the Sex Oﬀ ender Registration Act? *

Are you currently charged with or have you been convicted of a forcible felony? *

Certiﬁ cation Statement

Under penalties of perjury, I declare that I have examined this Form and all supporting documents and/or information submitted by me in connection

therewith, and to the best of my knowledge, they are true, correct, and complete. I understand if I provide false/fraudulent information I could lose my

license, be ﬁ ned and/or have other penalties assessed. I also understand the FEES ARE NOT REFUNDABLE.

Signature of Applicant Date

INCOMPLETE REINSTATEMENT: Incomplete forms will be returned and result in a substantial delay in the reissuance

of your license. Please assure your reinstatement application is completed in full and includes the required fee and your signature. Fee must be a

check or money order, payable to the IDFPR. Do not mail cash.

Check / Money Order. Check Number: _____________

Online. Paid Online at:https://idfpr.illinois.gov/epay.html in the amount of ______________. Approved #:______________

Payment Method