TX HHS Form 1351. Request to Withdraw from the CLASS Application Process

The Texas Health and Human Services (HHS) Form 1351, Request to Withdraw from the CLASS Application Process, serves as a means for individuals to decline participation in the Community Living Assistance and Support Services (CLASS) Program. This form allows applicants to specify reasons for withdrawing from the application process, including being met through other services or programs.

The purpose of this form is to provide a formal mechanism for individuals to opt out of the CLASS Program, which offers individualized services to persons with related conditions living in the community. By completing and submitting Form 1351, applicants can formally decline participation in the program and request to be added to the CLASS interest list for future consideration.

This form is intended for use by individuals who have received information about the CLASS Program and wish to withdraw from the application process. The issuing agency, Texas HHS, provides this form as a tool for applicants to exercise their right to decline participation in the program. By completing Form 1351, applicants can ensure that their decision to withdraw is formally recorded.