Hearing Instrument Dispenser 
Initial Application

Application

Application for Certification as a Hearing Instrument Dispenser (PDF)

Criminal Background Check Updates

One Time License Fee Surcharge for New Applicants

Effective October 1, 2018, all individuals applying for hearing instrument dispenser certification must pay a one-time surcharge of $22.50 to process a criminal background check (CBC) Minnesota Statutes, section 153A.17(1). Applicants submitting an application must provide a check or money order payable to the “Minnesota Department of Health” for the license application fee including the one-time CBC surcharge.

Hearing instrument dispensers who were certified before January 1, 2018, shall pay a onetime surcharge of $22.50 to renew their certification when it expires after October 31, 2020. The surcharge shall cover the commissioner's costs associated with criminal background checks.

Please note that new applicants are also required to pay an online applicant background study fee to the Department of Human Services (DHS). Instructions for completing the background study can be accessed here: Applicant Background Study Instruction Form (PDF) We recommend applicants mail their certification application to MDH and start the online background study process on the same day.