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

The TX HHS Form 2811, Youth Empowerment Services Waiver Letter of Withdrawal, is used to notify a legally authorized representative that an organization has attempted to contact them regarding their child's or youth's eligibility for the Youth Empowerment Services (YES) Waiver. This form helps solve the problem of ensuring that interested parties are informed and have the opportunity to withdraw from the inquiry list.

This letter requires the following information: the name of the individual, the name of the legally authorized representative, their address, city, state, and ZIP code, as well as the date. The form also mentions common scenarios of use, such as when an organization has been unable to reach a party by telephone to determine demographic eligibility.

The key feature of this form is its notification of withdrawal from the inquiry list. If the legally authorized representative does not respond within 10 days, their child or youth's name will be removed from the YES Waiver interest list. The form also provides contact information for questions, concerns, or to request re-enrollment in the future.