TX HHS Form 3038. Childrens Autism Program Family Cost Share Attestation Worksheet

The TX HHS Form 3038, Children's Autism Program Family Cost Share Attestation Worksheet, helps families determine their cost share for autism services. This form is used to calculate the family's annual income and deductions, ensuring accurate determination of their financial responsibility. Typically, parents or guardians complete this form in conjunction with a contractor to attest that the provided information is correct.

The form requires families to provide gross income information from various sources, including paycheck stubs or other documentation. Additionally, it asks for allowable deductions, such as medical expenses not covered by insurance, co-pays, and deductibles. The form also includes a section for parents or guardians to attest that the provided information is correct.

To complete this form, families must provide required information, including gross income and allowable deductions. They must also sign the form attesting to its accuracy. This form is an essential tool for families seeking autism services through the Texas Health and Human Services (HHS) Children's Autism Program.

• This form helps families determine their cost share for autism services.
• Families typically complete this form in conjunction with a contractor.
• The form requires gross income information from various sources.
• Allowable deductions include medical expenses not covered by insurance.