TX HHS Form 3623. Approval of Application for CLASS

The TX HHS Form 3623, Approval of Application for CLASS, is a crucial document that facilitates enrollment in the Community Living Assistance and Support Services (CLASS) Program. This form helps solve the problem of verifying an individual's eligibility to receive CLASS services, which are designed to support individuals with disabilities or chronic illnesses.

This form requires essential information from applicants, including their name and address, Medicaid number, and the names of their Direct Service Agency, Case Management Agency, and Consumer Directed Services Agency (if applicable). The form also indicates the effective date of enrollment, marking the start of authorized CLASS services. Common scenarios of use include initial applications for CLASS services or updates to existing enrollments.

The TX HHS Form 3623 is an important tool for individuals seeking to access CLASS Program services. By approving an application, this form confirms eligibility and authorizes the provision of necessary support services. With its clear structure and required information, this form ensures a smooth enrollment process for participants in the CLASS Program (Form 3623: Approval of Application for CLASS).