TX HHS Form 3470. Request for Advance or Reimbursement (RAR) Centers for Independent Living Base/Operation Grant

The TX HHS Form 3470, Request for Advance or Reimbursement (RAR) Centers for Independent Living Base/Operation Grant, is a crucial document used to request funding advances or reimbursements from the Texas Health and Human Services (HHS) for independent living services. This form helps solve the problem of managing grant funds and ensuring that expenses are properly accounted for.

This form requires key information such as payee ID number, service provider details, contract number, address, and phone number. The report period start and end dates must be specified, along with the budget period and total cumulative expenditures. The type of payment requested is also crucial, with options to enter amounts over or under receipts from previous periods.

The form includes important sections for certification and approval, where the financial officer's signature and date are required. The document explicitly mentions that any false or fraudulent information may subject the submitter to criminal, civil, or administrative penalties. This form should be used by centers for independent living services seeking funding advances or reimbursements from HHS.