Application for Lead Worker Licensure and Renewal

IOCI 17-558

Lead ID Number L -

Lead ID Number HDE -

FOR DEPARTMENT USE ONLY

LEAD ABATEMENT WORKER APPLICATION RENEWAL FOR LEAD ABATEMENT WORKER

$50.00 Annual licensure fee for applicants requesting an initial or the renewal of an existing license

$25.00 Late licensure fee if received after March 1

$25.00 Reinstatement licensure fee for each year if expired fewer than three years (Expired more than three years must submit

a new application)

Must be at least 18 years of age. *All Fees Are Non-refundable and Non-transferrable*

Make remittances payable to Illinois Department of Public Health (IDPH)

Applicant’s Legal Information

Last Name: First Name: MI:

Mailing Address: City: State: ZIP Code: County:

Phone Number: Fax: Date of Birth (mm/dd/yyyy): Social Security Number:

E-mail: Website (if applicable):

In accordance with the requirements of the Illinois Administrative Procedure Act, 5 ILCS 100, IDPH requires the disclosure of your social security

number as part of the license application. Failure to provide your social security number shall result in the denial of your license application.

Employer Information

Company Name: Phone Number: Fax:

Mailing Address: City: State: ZIP Code: County:

Website (if applicable):E-mail:

It is required by law (5ILCS/100/10-65) that all applicants shall complete and sign the following statement: Failure to complete this

statement will result in the return of your application and delays in processing your license. Making a false statement may place you in

contempt of court. Please check only one of the choices below that best applies to you. Note: your license will not be issued until this

section is completed. (CHECK ONLY ONE BOX)

I AM more than 30 days delinquent in complying with any child support order.

I AM NOT more than 30 days delinquent in complying with any child support order.

This statement does not apply.

Public Information Disclosure: By making a selection below, you authorize IDPH to publish or withhold your business or personal

information on all IDPH listings. Applicants who DO NOT complete the below information will have their personal information included

in IDPH listings by default. Your signature further confirms your agreement to hold harmless and release IDPH from any liability arising

from release of the information authorized below.

Personal Information Business Information I do not wish to be listed

Attach a clear, current, color

passport size (2” x 2” exact size)

photograph with tape here.

The picture shall have the

printed name of the applicant on

the reverse side of the photo.

Licenses will not be issued

without an identification

photograph.

I hereby certify that the information submitted is true and valid and I understand that the Illinois

Department of Public Health may deny, revoke or suspend my application for a Lead Professional

License for knowingly making false or fraudulent claims.

Signature: Date:

Important Notice: This state agency is requesting disclosure of information that is necessary to accomplish the

statutory purpose as outlined under public law PA 87-175. Disclosure of this information is mandatory. Failure

to provide any information could result in denial, revocation or suspension of the applicant’s license.

This application shall be signed and dated. Application forms are processed in the order they are received. Walk-in applicants will have their applications

added to that day’s work and the licenses mailed to them. E-mailed and faxed applications will not be accepted. Please allow 4 weeks for the

Department to process the application and send the license in the mail. For additional information you may contact the Illinois Lead Program at

217-782-3517. Mail to: Illinois Department of Public Health, Division of Environmental Health, Illinois Lead Program, 525 W. Jefferson St., 3rd Floor,

Springfield, IL 62761.

Application for Lead Worker Licensure and Renewal

IOCI 17-558

Individual Licensing Requirements for Lead Activities – Illinois Lead Poisoning Prevention Code

Section 845.125

a) To conduct any lead services, including lead inspection, lead risk assessment, lead hazard screen, lead mitigation, and lead

abatement work and supervision, in a regulated facility in Illinois, an individual shall be licensed in accordance with the Act and

this Section. To qualify for a license as a lead inspector, lead risk assessor, lead supervisor, or lead worker, an applicant shall

meet the following requirements:

1) Be at least 18 years of age

2) Submit the IDPH-approved lead training course certificate

A) The training course completed shall be for the discipline for which licensure is sought.

B) Training course certificates are valid for three years from the date the applicant passed the approved lead training

course examination.

C) Training course certificates shall be renewed every three years by successfully completing an IDPH-approved refresher

training course in the appropriate discipline.

D) If four years have passed since the applicant passed the approved training course examination, the training course

certificate cannot be refreshed. An applicant is required to complete the initial lead training course as required by this

Section.

3) Submit a recent 2” x 2” photograph of the applicant for proper identification of the licensee; the picture shall have the

printed name of applicant on the reverse side and the license will not be issued without an identification photograph

4) Submit the appropriate completed application form provided by IDPH

5) Submit the required license application fee

6) For applicants seeking initial licensure as a lead inspector, lead risk assessor, and lead supervisor, the applicant must meet

the third party examination requirements of subsection (e) of this Section and Section 845.135 of this Part

b) Fees for Lead Licensure, Renewal, Late Renewals, and Reinstatement of Expired Licenses

1) Applicants for an initial lead license or renewal of an existing lead license shall pay an annual non-refundable fee as

specified below

A) Lead worker license − $50

B) Lead supervisor license − $100

C) Lead inspector license − $100

D) Lead risk assessor license − $100

2) In addition to the annual renewal license fee, an applicant shall pay a nonrefundable late fee of $25:

A) If a renewal application for a lead inspector or lead risk assessor license is received after January 1; or

B) If a renewal application for a lead worker or a lead supervisor license is received after March 1.

3) An applicant whose license has been expired for a period fewer than three years may apply to IDPH for reinstatement of

the license. IDPH shall issue a reinstated license provided that:

A) The applicant pays to IDPH the current license fee applicable to the discipline to be reinstated, in accordance with

subsection (b)(1); and

B) The applicant pays a non-refundable reinstatement fee based on the following:

i) Lead workers: $25 for each year the license has expired; and

ii) Lead supervisors, inspectors and lead risk assessors: $50 for each year the license has expired.

4) A license that has been expired for more than three years may be restored only by submitting a new application in

accordance with subsection (a) of this Section.

c) All lead licenses expire annually in accordance with the following:

Application for Lead Worker Licensure and Renewal

IOCI 17-558

1) Lead inspector and lead risk assessor licenses expire January 31 of each year, except that a first-time license issued after

October 31 and before January 31 shall expire the next following January 31; and

2) Lead worker and lead supervisor licenses expire March 31 of each year, except that a first-time license issued after

December 31 and before March 31 shall expire the next following March 31.

d) Renewal of License - Any license issued pursuant to this Part may be renewed if the licensee submits:

1) The completed renewal application

2) The non-refundable license renewal fee outlined in subsection (b)(1)

3) A recent 2” x 2” photograph of the applicant for proper identification of the licensee; the picture shall have the printed

name of the applicant on the reverse side and the license shall not be issued without an identification photograph

4) A current certificate of completion from an IDPH-approved training course in accordance with subsection (a)(2) of this Section

e) In addition to meeting the general requirements outlined in subsections (a) and (b) of this Section, lead inspector, lead risk

assessor and lead supervisor disciplines have specific training course requirements, examination and education and experience

requirements as specified in this subsection (e):

1) To qualify for a license as a lead risk assessor, a person shall:

A) Submit the training course completion certificates, including one of the two following combinations:

i) An initial lead inspector training course certificate and any subsequent refresher certificates required to maintain

accreditation as outlined in subsection (a) of this Section, and an initial lead risk assessor training course

certificate, and any subsequent refresher certificates required to maintain accreditation as outlined in subsection

(a) of this Section; or

ii) An initial lead risk assessor training course certificate and any subsequent refresher certificates required to

maintain accreditation as outlined in subsection (a) of this Section, and a current Illinois lead inspector license.

B) Possess one of the following combinations of education and experience:

i) A Bachelor of Science degree in engineering, environmental, or health-related field; or

ii) A bachelor's degree in any discipline and one year of experience in a related field (e.g., lead, asbestos or

environmental remediation work, or construction); or

iii) An associate's degree in any discipline and two years of experience in a related field (e.g., lead, asbestos or

environmental remediation work, or construction); or

iv) A high school diploma (or equivalent) and at least three years of experience in a related field (e.g., lead, asbestos

or environmental remediation work, or construction); or

v) Licensure as an industrial hygienist, professional engineer, architect, or environmental health practitioner; and

C) Pass IDPH’s third party examination for lead risk assessor as required by Section 845.135.

2) To qualify for a license as a lead inspector, a person shall:

A) Submit the training course completion certificates, including an initial lead inspector training course certificate and any

subsequent refresher certificates required to maintain accreditation as outlined in subsection (a) of this Section; and

B) Pass the IDPH’s third party examination for lead inspector as required by Section 845.135.

3) To qualify for a license as a lead supervisor, a person shall:

A) Submit the training course completion certificates, including an initial lead supervisor training course certificate and any

subsequent refresher certificates required to maintain accreditation as outlined in subsection (a) of this Section; and

B) Meet the experience requirements as follows:

i) One year of experience as a certified lead-based paint abatement worker; or

ii) Two years of experience in a related field (e.g., lead, asbestos, or environmental remediation work) or in the

building trades.

C) Pass the IDPH’s third party examination for lead supervisor as required by Section 845.135.