85 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
APPLICATION FOR MINNESOTA RAP FIRM OR RAP SOLE PROPRIETOR PERMIT
INSTRUCTIONS
Please refer to the following rules regarding RAP Firm licensure:
•
Initial firm permit requirements: MN Rules 1105.7100-7700
•
Peer review: MN Rules 1105.4600 to 1105.5500
•
Firm name: MN 1105.6300 to 1105.6400
Refer to the
Minnesota Secretary of State’s office
for their rules regarding forming a business in Minnesota.
Complete and return these REQUIRED items:
1. Firm Permit Application (pages
1
and 2).
The application must be notarized.
2. Firm Peer Review Statement (page 3)
3. Workers’ Compensation Liability Certificate of Compliance (page 4)
4. Minnesota firms other than sole proprietorships: Enclose a certified copy of the Articles of Incorpora-
tion, Articles of Organization, or LLP registration on file with the Minnesota Secretary of State’s Office.
Non-Minnesota (“foreign”) firms: Enclose a certified copy of your Certificate of Authority from the
Minnesota Secretary of State’s Office.
5. Firm permit application fee:
$100.00
Complete and return the following items if applicable:
1. Minnesota Non-RAP Owner of Firm Statement Form (page 5)
Complete a form and include $45.00 fee for each Minnesota non-RAP owner.
question 2 on page
1)
2. List of firm locations (see
3. A copy of any peer review completed within the last year (see Firm Peer Review Statement, page 3). If
existing, include Final Acceptance Letter, Reviewer’s Report, Letter of Comment, Letter of Response, and
Corrective Action.
Once all of the required documents are received, your application will be presented to the Board at the next
regularly scheduled
meeting.
If you have questions regarding your application, please call the Board office at 651-296-7938.
DATA PRACTICES ACT WARNING
The data you furnish on this form will be used by the Board to process your application for licensure. You are not legally required to provide this
data; however, if you fail to do so, the Board may be unable to issue your license. Until licensure is granted all application data, except name and
designated address, are private data pursuant to Minnesota Statutes section 13.41, subdivision 2 (2016). All data except social security number
become public record when licensure is granted pursuant to Minnesota Statutes section 13.41, subdivision 5 (2016).
Application for RAP Firm/Sole Proprietor Permit—INSTRUCTIONS