TX HHS Form 1017. Burial or Cremation Assistance Registry Application

Form 1017 is an official application used in Texas by funeral homes, cemeteries, and qualifying nonprofit organizations to request placement on the Burial or Cremation Assistance Registry. This registry is maintained by the Texas Health and Human Services Commission (HHSC) and lists organizations willing to provide financial or practical assistance related to the transportation, burial, or cremation of embryonic or fetal tissue.

The form serves as a formal declaration that an organization meets statutory requirements and agrees to provide limited, regulated assistance under Texas law.

Purpose of the Form

The main purpose of Form 1017 is to allow eligible organizations to be publicly listed as assistance providers when burial or cremation services are required under state law. Inclusion on the registry enables HHSC and other parties to identify organizations willing to help families or facilities meet legally mandated disposition requirements.

This form is required only for organizations that choose to participate in the registry. It is not mandatory for all funeral homes, cemeteries, or nonprofits.

When This Form Must Be Submitted

Form 1017 must be submitted when an organization wants to be added to the Burial or Cremation Assistance Registry. Common situations include:

• A funeral home deciding to offer low-cost or free services for regulated cases
• A cemetery agreeing to assist with burial services under state requirements
• A nonprofit organization offering financial or logistical support

The form is not required if an organization does not wish to be listed or does not provide assistance related to embryonic or fetal tissue disposition.

Who Is Authorized to Complete the Form

The form must be completed and signed by an individual who has authority to act on behalf of the organization. This is typically an owner, director, executive officer, or authorized manager. By signing, the individual certifies the accuracy of the information and the organization’s willingness to comply with registry requirements.

Explanation of Key Sections

Organization Information

This section identifies the applying organization. It includes the organization’s name, mailing address, phone number, website, email address, and a designated contact person. Accurate contact details are essential, as registry information may be released upon request.

Organization Type

The applicant must indicate whether the organization is a funeral home, cemetery, or private nonprofit organization. Only these entity types are eligible for inclusion on the registry.

Type of Assistance Offered

This section documents what kind of support the organization is willing to provide. Options include:

• Free or low-cost transportation, burial, or cremation services
• Financial assistance
• Other forms of assistance, if specified

Organizations are expected to provide only the assistance types they select.

Certifications and Acknowledgments

By signing the form, the organization certifies compliance with Texas Health and Safety Code Section 697.005 and 25 Texas Administrative Code Section 138.8. The applicant acknowledges that:

• Incomplete or false information will result in disapproval
• Registry information may be released upon request
• Failure to provide agreed services may result in removal from the registry

Legal and Regulatory Context

Texas law requires the respectful disposition of embryonic or fetal tissue through burial or cremation. Form 1017 supports this requirement by creating a vetted list of organizations willing to assist with these services. The registry helps ensure compliance with state standards while offering options for financial or logistical support.

Practical Tips for Completing Form 1017

• Confirm that your organization meets eligibility requirements before applying.
• Clearly indicate only the services you are prepared to provide.
• Ensure contact information is accurate and monitored.
• Have the form signed by an authorized representative.
• Retain a copy of the submitted application for your records.

Common Mistakes to Avoid

• Selecting assistance options the organization cannot reliably provide
• Submitting the form without proper authorization
• Providing incomplete contact information
• Failing to understand removal conditions from the registry

Real-Life Situations Where This Form Is Used

• A funeral home decides to participate in the registry to offer reduced-cost cremation services.
• A nonprofit organization applies to provide financial assistance for regulated burial services.
• A cemetery agrees to support burial arrangements required under state law.

Documents Commonly Needed with This Form

• Internal authorization to apply on behalf of the organization
• Organizational contact and identification details
• Service descriptions or internal policies (if requested)

Frequently Asked Questions

Is Form 1017 mandatory?

No, it is only required if an organization wants to be listed on the registry.

Who can apply using this form?

Eligible funeral homes, cemeteries, and private nonprofit organizations.

Can registry information be shared publicly?

Yes, registry information may be released upon request.

What happens if an organization does not provide agreed services?

The organization may be removed from the registry.

Does being listed create a legal obligation?

It creates an expectation to provide the selected assistance types.

Related Forms

• Disposition Authorization Forms
• Funeral Services Provider Registration Forms
• Nonprofit Compliance Documentation

Form Details

• Form Name: Burial or Cremation Assistance Registry Application
• Form Number: 1017
• State: Texas
• Governing Authority: Texas Health and Human Services Commission
• Revision Date: November 2022