TX HHS Form 3258. Licensed Chemical Dependency Counselor Program Peer Assistance Program Access Attestation

The TX HHS Form 3258, Licensed Chemical Dependency Counselor Program Peer Assistance Program Access Attestation, is a crucial document for individuals seeking licensure or renewal of their licensed chemical dependency counselor (LCDC) registration or license. This form helps solve the problem of ensuring that applicants have access to an approved peer assistance program, as required by Texas Occupations Code Chapter 504.

The form consists of three sections: Personal Information, Peer Assistance Program Access Information, and Signature and Attestation. In Section 2, applicants must indicate whether they have access to a peer assistance program or provide a reason for not having access. If the applicant selects "No" above, they must describe the reason. HHSC may waive the requirement if it determines that a peer assistance program is not reasonably available to the license holder.

This form should be used by applicants seeking LCDC registration or initial licensure, as well as current LCDC license holders renewing their licenses. The completed application should be mailed or emailed to the Texas Health and Human Services Commission Professional Licensing and Certification Unit at PO Box 149347, Mail Code 1982 Austin, Texas 78714-9347 or [email protected].