TX HHS Form 1571. Request for Partial Reimbursement for the Cost Installation of a Fire Sprinkler System in a Four-Person Residence

The TX HHS Form 1571 is a request for partial reimbursement for the cost of installing a fire sprinkler system in a four-person residence. This form helps solve the problem of covering the expenses associated with installing a life-saving system that meets state regulations. The form is typically used by program providers who have installed fire sprinkler systems in residences and are seeking reimbursement from the Texas Health and Human Services Commission (HHS).

The form requires specific information, including the address of the four-person residence, the date the installation was completed, and the total cost of the installation. The installer must also provide a State Fire Marshal's Office Form SF041 or SF042, depending on the type of piping used. Additionally, an invoice or statement from the fire sprinkler installation company is required, showing that the work has been paid for and meets certain conditions outlined in Texas Administrative Code (TAC) Title 28, Part 1, §34.716.

To complete this form, program providers must email it to [email protected] by June 30, 2017, along with the required supporting documentation. The subject line of the email must include the address of the four-person residence, including city and ZIP code. By following these instructions and providing the necessary information, program providers can successfully request partial reimbursement for the cost of installing a fire sprinkler system.

• The form is used by program providers to request partial reimbursement for the cost of installing a fire sprinkler system in a four-person residence.
• The installer must provide a State Fire Marshal's Office Form SF041 or SF042, depending on the type of piping used.
• An invoice or statement from the fire sprinkler installation company is required, showing that the work has been paid for and meets certain conditions outlined in Texas Administrative Code (TAC) Title 28, Part 1, §34.