TX HHS Form 5013. Contractor Referral

The TX HHS Form 5013, Contractor Referral, is a crucial document that helps solve the problem of identifying potential wards in need of guardianship services. This form is typically used by Adult Protective Services (APS) workers to refer individuals who require guardianship due to various reasons such as medical diagnoses or inability to make informed decisions.

The form requires essential information about the proposed ward, including their name, social security number, date of birth, and county of residence. Additionally, it asks for details about the referral, such as the APS worker's name, area code, and phone number, as well as the HHS contact person and regional office. The form also includes sections for listing sources, amounts, and frequency of income for the potential ward.

Key features of this form include the requirement to provide a brief description of why guardianship is necessary for the proposed ward, as well as information about any collateral contacts that may be relevant. The contractor signatory or designee must also accept or decline the referral from HHS and provide their signature and date.

• The TX HHS Form 5013 is used by Adult Protective Services (APS) workers to refer individuals who require guardianship.
• The form requires essential information about the proposed ward, including their name, social security number, and county of residence.
• The contractor signatory or designee must accept or decline the referral from HHS and provide their signature and date.