TX HHS Form 3239. Initial Licensed Sex Offender Treatment Provider or Affiliate Sex Offender Treatment Provider Licensure Application

The TX HHS Form 3239, Initial Licensed Sex Offender Treatment Provider or Affiliate Sex Offender Treatment Provider Licensure Application, is a crucial document for professionals seeking licensure to provide sex offender treatment services in the state of Texas. This form helps solve the problem of ensuring that individuals with the necessary qualifications and expertise are authorized to offer treatment services to sex offenders.

The application requires applicants to provide personal contact information, including date of birth, social security number, and ethnicity. Additionally, applicants must disclose any name changes and attach legal documentation if applicable. The form also collects employment information, including primary employer details and area codes and phone numbers for both the primary office and other counties where services are provided. A copy of the applicant's primary mental health or medical license is also required to be submitted with this form.

This form is typically used by professionals seeking licensure as either an Initial Licensed Sex Offender Treatment Provider (LSOTP) or Affiliate Sex Offender Treatment Provider (ASOTP). Key requirements include providing a copy of the primary mental health or medical license and disclosing any name changes. The following are key points to consider when completing this form:

• Applicants must provide personal contact information, including date of birth and social security number.
• A copy of the applicant's primary mental health or medical license is required.
• Name changes must be disclosed and legal documentation attached if applicable.