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

The Texas Health and Human Services (HHS) Form 1571 is used to request partial reimbursement for the cost of installing a fire sprinkler system in a four-person residence. This form is intended for program providers who have installed fire sprinkler systems in their facilities and are seeking reimbursement from HHS.

In accordance with Information Letter (IL) 17-07, the completed form must be emailed to the Texas Health and Human Services Commission (HHSC) along with supporting documentation by June 30, 2017. The subject line of the email must include the address of the four-person residence, including city and ZIP code. Required supporting documents include State Fire Marshal's Office Forms SF041 and SF042, as well as an invoice or statement from the fire sprinkler installation company showing the total cost of the installation.

This form is used to request partial reimbursement for the cost of installing a fire sprinkler system in a four-person residence. The purpose of this form is to provide program providers with a means of requesting reimbursement for the costs associated with installing fire sprinkler systems in their facilities. By using this form, program providers can ensure that they are in compliance with relevant regulations and guidelines.