TX HHS Form 3632. Withdrawal Confirmation

The TX HHS Form 3632, Withdrawal Confirmation, is a crucial document that helps individuals withdraw from the Texas Money Follows the Person Demonstration Program. This form is typically used when an individual decides to opt out of the program, which provides financial assistance for long-term care services.

This form requires the individual's name, mailing address, and contact information, as well as the signature of the individual or their authorized representative. Upon submission, the participant will be removed from the demonstration program effective the date of their signature on this form. The case manager/service coordinator is responsible for receiving the completed form.

Key points to note include: