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) license in Texas. This form helps ensure that applicants have access to an approved peer assistance program, as mandated by the Texas Occupations Code Chapter 504.

The form requires applicants to provide personal information, including their area code and phone number, license number (if current), and email address. Additionally, they must indicate whether they have access to a peer assistance program or describe the reason for not having access if they selected "No". The Texas Health and Human Services Commission may waive the requirement if it determines that a peer assistance program is not reasonably available to the license holder.

To complete the form, applicants must attest that all information provided is true and correct. Intentionally false or misleading statements may result in their being declared ineligible for licensure. The completed application should be mailed or emailed to the Texas Health and Human Services Commission's Professional Licensing and Certification Unit at PO Box 149347, Mail Code 1982, Austin, Texas 78714-9347, or sent via email to [email protected].

• This form is required for applicants seeking licensure or renewal of their LCDC license in Texas.
• The form helps ensure that applicants have access to an approved peer assistance program.
• The applicant must provide personal information and indicate whether they have access to a peer assistance program.