TX HHS Form 1051. Request for Determination of Intellectual Disability (DID)

The Texas Health and Human Services (HHS) Form 1051 is a request for determination of intellectual disability (DID), used by the Local Intellectual and Developmental Disability Authority (LIDDA). This form is designed to gather essential information about an individual seeking a DID diagnosis, including their contact details, Medicaid number, and social security number. The purpose of this form is to facilitate the evaluation process and ensure that individuals receive the necessary support and services.

This form is intended for use by professionals working with individuals who may have intellectual disabilities, such as those in child protective services or managing conservatorship. It provides a standardized framework for collecting information about an individual's age, address, and current placement, as well as their LIDDA contact details. The form also includes sections for reassigned LIDDA information and local procedure development and support.

The HHS Form 1051 is an essential tool for determining intellectual disability in Texas. By submitting this form, individuals can initiate the evaluation process and access necessary services and support. For questions regarding this form, please contact [email protected] or refer to the instructions provided.