TX HHS Form 5059. Application Statement

The TX HHS Form 5059, Application Statement, is a crucial document for individuals seeking Comprehensive Rehabilitation Services. This form helps applicants demonstrate their understanding of the program's requirements and their willingness to participate in necessary evaluations.

This application statement highlights key features such as the requirement for complete and accurate financial information, as well as the applicant's agreement to participate in all necessary evaluations. The form also emphasizes the importance of receiving a copy of the HHS Ombudsman Brochure and understanding CRS' right to pursue reimbursement for services if the applicant receives a judgment or insurance settlement related to their disability.

The TX HHS Form 5059, Application Statement, should be used by individuals applying for Comprehensive Rehabilitation Services. This form is essential for applicants seeking rehabilitation services, as it serves as a declaration of their understanding and agreement with the program's requirements.