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 the enrollment process in the Community Living Assistance and Support Services (CLASS) Program. This form helps solve the problem of ensuring eligible individuals can access necessary services to maintain their independence and quality of life.

This form is typically used by applicants who are seeking enrollment into the CLASS Program. The applicant's information, including name, address, and Medicaid number, must be provided to initiate the application process. Upon review, the application will be deemed eligible or ineligible for enrollment, with a specified effective date for service authorization.

The form also identifies the Direct Service Agency, Case Management Agency, and Consumer Directed Services Agency (if applicable) involved in the applicant's care. The signature of the Case Manager and the date of approval are also required. Key points to note include:

• Eligibility for enrollment into the CLASS Program
• Authorization for service provision on or after a specified date
• Naming of Direct Service, Case Management, and Consumer Directed Services Agencies (if applicable)