TX HHS Form 3243. Affiliate Sex Offender Treatment Provider or Licensed Sex Offender Treatment Provider Name Change or Duplicate License Application

The TX HHS Form 3243, "Affiliate Sex Offender Treatment Provider or Licensed Sex Offender Treatment Provider Name Change or Duplicate License Application", is used to request a name change or duplicate license for sex offender treatment providers in Texas. This form helps solve the problem of updating provider information or obtaining replacement licenses when necessary.

The form consists of four sections: Licensee Profile Data, Duplicate License Request, Duplicate License Fee, and Signature. In Section 1, providers must provide their former name (if applicable). For a name change request, providers must attach supporting documentation, such as a photocopy of a new Social Security card or driver's license, or marriage certificate. If holding multiple licenses, it is the provider's responsibility to notify each program or board regarding the name change request.

This form should be used when a sex offender treatment provider in Texas needs to update their information due to a name change or requires a duplicate license and renewal cards. The $10 fee required by Texas Administrative Code Title 22 §810.5(i) must be included with the application package, which should be mailed to HHS ARTS at P.O. Box 149055 Austin, Texas 78714-9055. For questions, providers can email [email protected].