TX HHS Form 2811. Youth Empowerment Services Waiver Letter of Withdrawal

The TX HHS Form 2811: Youth Empowerment Services Waiver Letter of Withdrawal is a crucial document that helps solve the problem of individuals withdrawing from the inquiry list for the YES Waiver program. This form is typically used in situations where an individual or their legally authorized representative wishes to remove themselves from the interest list.

This letter serves as formal notification to the organization that the individual has attempted to contact them regarding eligibility and enrollment in the YES Waiver. Key features of this document include the required information such as the name of the individual, their address, and the reason for withdrawal. The form also outlines conditions and responsibilities, including the removal of the child or youth from the interest list if no further action is taken within 10 days.

The TX HHS Form 2811: Youth Empowerment Services Waiver Letter of Withdrawal provides a clear process for individuals to withdraw from the inquiry list. Key points include:

• Notification of withdrawal must be provided in writing
• The organization will remove the child or youth from the interest list if no further action is taken within 10 days
• Individuals may reapply to join the interest list at a later date
• Contact information for questions, concerns, or errors is provided