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 solve the problem of requesting amelioration from Texas Health and Human Services (HHS) for existing programs.

This form requires completion of two main sections: Program Provider Information and Legal Entity or Owner Information. The first section asks for details such as program provider name, contract number, exit date, administrator's name, phone numbers, and fax information. The second section requests similar information about the legal entity or owner, including contact person's name, phone numbers, and fax information.

The form also includes a section on Disclosure Information, where applicants must provide details on how they plan to fund their proposed plan. This may include information on available funds, lines of credit, or other financial resources. It is essential to note that amelioration is not offered more than three times in a two-year period or more than one time for the same or similar violation within the same timeframe.