TX HHS Form 1728. Liability Acknowledgement

The Texas Health and Human Services (HHS) Form 1728, Liability Acknowledgement, is a crucial document for individuals seeking employment through the Consumer Directed Services (CDS) option. This form serves as a liability acknowledgement between the employer and applicant for employment, outlining the responsibilities of both parties.

As an applicant for employment through the CDS option, it is essential to understand that the employer is solely responsible and liable for any negligent acts or omissions by themselves, their employees, or contractors. The employer is not employed or retained by the Texas HHS Commission, state or federal governmental agencies, or the Financial Management Services Agency (FMSA). By signing this form, applicants acknowledge that they have read and understand these terms.

This liability acknowledgement also includes information about workers' compensation insurance, with employers required to indicate whether they are subscribers of Texas Workers' Compensation through the Texas Department of Insurance, Division of Workers' Compensation. The form provides a clear outline of the employer's responsibilities in case of employee work-related injuries or illnesses and serves as a vital tool for ensuring compliance with relevant regulations.