TX HHS Form 2270. Caregiver Intake

The TX HHS Form 2270, Caregiver Intake, is a crucial document used to provide services for caregivers. This form helps identify the caregiver's information and request specific services.

This intake form requires essential details about the caregiver, including their last name, first name, date of birth, sex, phone number, email address, mailing address (if different from home), ethnicity, race, marital status, and whether they live alone. Additionally, it asks about the total number of people in their household and monthly income. The form also includes a section for listing requested services.

The information provided on this form is confidential and will only be used to initiate or change services. It's essential to note that all items marked with an asterisk (*) are required, ensuring accurate and complete submission. This form should be used by caregivers seeking assistance from the Area Agency on Aging of Texas Health and Human Services.