TX HHS Form 3632. Withdrawal Confirmation

The TX HHS Form 3632, Withdrawal Confirmation, is used to confirm an individual's decision to withdraw from participation in the Texas Money Follows the Person Demonstration Program. This form should be completed when an individual chooses to discontinue their involvement in the program.

This form requires the individual's name, mailing address, and contact information, as well as the signature of the individual or their authorized representative. The form also includes a section for the case manager/service coordinator to return the completed form.

The TX HHS Form 3632 is an important tool for individuals who wish to withdraw from the Texas Money Follows the Person Demonstration Program. By completing this form, individuals can formally notify the program of their decision to withdraw and ensure a smooth transition out of the program.