TX HHS Form 3212. Birthing Center License Application

The TX HHS Form 3212, Birthing Center License Application, is a crucial document for birthing centers seeking to obtain or renew their license. This form helps solve the problem of providing essential information about the facility's ownership and operations, ensuring compliance with regulatory requirements.

This application requires key information such as the facility's doing business as (DBA) name, mailing address, phone number, and email address. The form also asks for details on the ownership structure, including the legal name of the entity responsible for day-to-day operations, employer identification number (EIN), and a copy of the IRS letter assigning the EIN or Certificate of Filing from the Office of the Secretary of State. Additionally, the form inquires about the type of ownership, whether it's a sole proprietorship, partnership, corporation, or management contract.

The TX HHS Form 3212 should be used by birthing centers seeking to obtain an initial license or change their existing license due to a change of ownership (CHOW). The form is designed to provide the necessary information for Texas Health and Human Services (HHS) to review and approve the application. By completing this form, birthing centers can ensure compliance with regulatory requirements and demonstrate their commitment to providing high-quality services.