Self Reporting Form Overview

The Self-Reporting Form (SRF) is the official reporting mechanism to submit in order to demonstrate completion of your CCA cycle. The CCA cycle dates are as follows:

Deadline for SRF

The completed SRF must be received by our National office by the reporting deadline October 1st. If your SRF is received after the deadline, it is ACNM policy that a $25 dollar late fee be charged in order to process your form. Please include a $25 check when submitting your SRF after the deadline. You will receive a letter confirming receipt of your SRF.  However, if you report after the October 1st deadline, in addition to the $25.00 late fee, you should also submit certificates of attendance to verify the CEUs that you are reporting.

Details of Reporting:

1. There is no fee required to submit your SRF before the deadline.
2. Report only 50 contact hours/ 5 continuing education units (CEUs) of ACNM approved or Accreditation Council for Continuing Medical Education (ACCME) Category I approved continuing education activities, or one of any of the four alternatives in lieu of CEUs. If you are not sure of ACNM or ACCME CEU approval, we suggest you report additional hours.
3. Do not send originals or copies of certificates of attendance or other documentation with your SRF. Maintain your own file of supporting documentation for your records of all your accrued CEUs throughout your cycle.
4. After the reporting deadline, ACNM will conduct a 10% random audit of your CCA cycle. If you are selected for the audit, you will be notified and given ample time to send copies of documentation of the reported activities. Please do not send originals of certificates or other documentation.
5. Once the audit is completed, Certificates of Satisfactory Completion or letters explaining unsatisfactory completion will be sent.
6. Enrollment dates and deadlines are listed above. You are invited to re-enroll in the next CCA cycle after the end date of your current cycle. An enrollment application will be sent at the close of your current cycle, or you can obtain one on ACNM's website, http://www.midwife.org/edu/cca.cfm.  Once your application is processed, you will receive a card verifying your enrollment in the CCA program.
7. Fax your SRF to: Continuing Education Coordinator (240) 485-1846 or mail to:

   ACNM Continuing Education Coordinator,
   8403 Colesville Road, Suite 1550
   Silver Spring, MD 20910

If you have any questions or concerns throughout your CCA cycle please call the Education Department (240) 485-1846.