TX HHS Form 1068. Withdrawal of Offer for Home and Community-based Services (HCS) Program

The Texas Health and Human Services (HHS) Form 1068, Withdrawal of Offer for Home and Community-based Services (HCS) Program, is a notification form used to inform individuals that their offer to enroll in the HCS program has been withdrawn. This situation typically arises when an individual fails to respond within a specified timeframe or does not complete necessary activities to finalize enrollment.

The form outlines the reasons for withdrawal, including lack of response, incomplete documentation, or failure to meet deadlines. It also provides information on reinstating one's name on the HCS interest list and the procedures for doing so. Key features of this form include the required information, such as the individual's name, CARE ID, and LIDDA name, as well as specific conditions and responsibilities.

This form is used in situations where an individual has been offered a spot in the HCS program but fails to meet the necessary requirements or deadlines. The form provides clear instructions on what actions to take next, including reinstating one's name on the interest list or requesting to be placed back on the list based on the original date of request. By using this form, individuals can understand their options and take the necessary steps to continue pursuing enrollment in the HCS program.

• The form is used when an individual's offer to enroll in the HCS program has been withdrawn due to lack of response or incomplete documentation.
• The form provides instructions on reinstating one's name on the HCS interest list and procedures for doing so.