TX HHS Form 5059. Application Statement

The TX HHS Form 5059, Application Statement, is a crucial document for individuals seeking comprehensive rehabilitation services in Texas. This form helps solve the problem of determining eligibility for these services by providing essential information about the applicant's needs and circumstances.

This application statement requires applicants to understand that they are applying for comprehensive rehabilitation services and agree to participate in necessary evaluations to determine their eligibility. Additionally, applicants must provide complete and accurate financial information, as required by Texas law. The form also outlines the responsibility of CRS (Comprehensive Rehabilitation Program) to pursue reimbursement for services purchased if the applicant receives a judgment or insurance settlement related to their disability.

The TX HHS Form 5059 is typically filled out by individuals seeking comprehensive rehabilitation services in Texas. Key features of this form include required information such as financial details and agreement to participate in evaluations. By completing this application, applicants can ensure that they are eligible for the necessary services to support their rehabilitation goals.

• Required information includes complete and accurate financial data
• Applicants must agree to participate in necessary evaluations
• CRS has the right to pursue reimbursement for services purchased if the applicant receives a judgment or insurance settlement related to their disability