TX HHS Form 3610. Informal Review Request

The TX HHS Form 3610, Informal Review Request, is a crucial document used to request an informal review of draft findings related to non-compliance principles. This form helps resolve issues by providing a mechanism for stakeholders to challenge or clarify the results of a review.

To initiate an informal review, users must submit this form within 10 calendar days of receiving the final report. The form requires completion of key sections, including Principle in Noncompliance (with principle number), Rationale for Informal Review Request, and Signature from both the Program Manager and Chief Executive Officer. Additionally, users must attach documentation related to the principle found in non-compliance.

This form should be used when a stakeholder wants to request an informal review of draft findings that identify principles out of compliance. The form can be submitted to Texas Health and Human Services Commission Regulatory Services Survey and Certification Enforcement Unit at 701 W. 51st Street, Mail Code E-351, Austin, TX 78751. If the submission is less than 50 pages, it can also be faxed to 512-438-4138.