TX HHS Form 2602. Application Acknowledgment

The TX HHS Form 2602, Application Acknowledgment, is used to acknowledge interest in Medically Dependent Children Program (MDCP) services. This form helps individuals or legally authorized representatives express their desire to apply for MDCP services, schedule an appointment to determine eligibility, or remove their name from the interest list.

This application acknowledgment form requires key information including the individual's or representative's name, mailing address, and contact details. The form also outlines common scenarios of use, such as expressing interest in applying for MDCP services, declining interest, or requesting to be contacted again in the future. It is essential to complete and return this form by the specified date to avoid removal from the interest list.

The TX HHS Form 2602, Application Acknowledgment, must be returned to the Program Support Unit (PSU) staff for processing. Failure to return the form by the deadline may result in removal from the interest list and no further action will be taken. However, it is possible to request that your name be placed back at the bottom of the MDCP interest list by contacting the PSU staff.