TX HHS Form 3624. Termination. Reduction or Denial of CLASS

The TX HHS Form 3624, Termination, Reduction or Denial of CLASS, is used to notify individuals that their participation in the Community Living Assistance and Support Services (CLASS) program will be terminated, reduced, or denied. This form helps solve the problem of managing changes to an individual's CLASS services.

This form requires the reason for termination, reduction, or denial to be specified, along with the effective date of the change. The notice also informs the individual that they have the right to request a hearing to appeal this decision and provides instructions on how to do so. Common scenarios of use include situations where an individual's eligibility for CLASS services is no longer valid or when their services are being reduced due to changes in their circumstances.

The form must be completed and returned within 90 days of the date of notice, as failure to request a hearing during this time period will result in the loss of the right to appeal. The full title of the form, including its number (Form 3624), is TX HHS Form 3624, Termination, Reduction or Denial of CLASS.