TX HHS Form 3708-A. HCS/TxHmL Amelioration Request

The TX HHS Form 3708-A, HCS/TxHmL Amelioration Request, is a crucial document for program providers seeking to address specific issues or violations. This form helps resolve problems by providing a structured framework for presenting proposed solutions and plans for improvement.

This form requires program providers to provide detailed information about their organization, including name, contract number, exit date, administrator's name, and contact details. Additionally, the form asks for legal entity or owner information, including the name of the entity or owner, contact person's name, and phone/fax numbers. The form also includes a section on disclosure information, where providers must outline their plan to fund their proposed solution.

The HCS/TxHmL Amelioration Request form is used in situations where program providers need to address specific issues or violations related to health and human services. Key features of this form include the requirement for program providers to demonstrate a commitment to improvement, as well as the provision of detailed information about their proposed plan.

• The form can be used up to three times in a two-year period for different violations, or once per year for the same or similar violation.