TX HHS Form 3622. Denial of Application for CLASS

The TX HHS Form 3622, "Denial of Application for CLASS," is a crucial document used to notify an applicant that their application for enrollment into the Community Living Assistance and Support Services (CLASS) Program has been denied. This form outlines the reasons for denial and provides the applicant with the opportunity to appeal the decision.

This form requires the Case Manager's signature and includes important sections such as the reason(s) for denial and instructions on how to request a hearing to appeal the decision. The applicant must complete the Request for Appeal (found on Page 2) and return the notice to the Services Office within 90 days of the date of this notice, or they will lose their right to a hearing.

The TX HHS Form 3622 is used when an application for CLASS enrollment has been denied. This form helps solve the problem of providing a clear explanation for denial and outlining the appeal process. It should be used by Case Managers to notify applicants of denial and provide them with the necessary information to request a hearing.