TX HHS Form 3088. Request for State Assistance Funds (90 Percent)

The TX HHS Form 3088, Request for State Assistance Funds (90 Percent), is a crucial document that helps healthcare providers request reimbursement from the Texas Health and Human Services (HHS) for health care services provided under the County Indigent Health Care Program. This form is typically used by county officials to seek funding for indigent health care services, ensuring that essential medical services are available to those in need.

This form requires the submission of specific information, including the State Assistance Request No., County Name, and County Vendor ID No. The payee must also acknowledge their responsibility to repay any funds paid in error and agree to the state's authority to collect such funds. Additionally, the form specifies that all requests for reimbursement must be submitted by August 31, 2020.

Key features of this form include:

• The request for reimbursement must be made by the end of August 31, 2020;
• The payee is responsible for repaying any funds paid in error;
• The state has authority to collect any funds paid in error.