TX HHS Form 3921. Multiple-Certificate Annual Renewal

The TX HHS Form 3921, Multiple-Certificate Annual Renewal, is a crucial document for individuals who hold multiple certifications from the Texas Health and Human Services (HHS) Office of Deaf and Hard of Hearing Services. This form helps to facilitate the renewal process, ensuring that certification holders maintain their credentials and continue to provide services to clients.

The form requires certificate holders to provide essential information, including name, birth date, BEI Certification No., and certification levels. Additionally, individuals must disclose any criminal convictions or disciplinary actions taken against them. The form also outlines the fee structure for recertification, with varying fees depending on the timing of payment. Certificate holders are responsible for submitting their completed forms along with the applicable fee to the HHS DHHS office.

To complete the form, certificate holders should follow these steps: submit a check, cashier's check, or money order payable to HHS DHHS; mail the form and fee to P.O. Box 12306, Austin, TX 78711; and allow 30 days for processing. Key points to keep in mind include:

• Multiple certifications must be renewed annually
• Certificate holders are required to disclose criminal convictions or disciplinary actions
• Fees vary depending on the timing of payment
• The form must be submitted with the applicable fee and mailed to HHS DHHS