TX HHS Form 5604. HCS Program Provider Request for Life Safety Inspection

The TX HHS Form 5604, HCS Program Provider Request for Life Safety Inspection, is a crucial document that helps solve the problem of ensuring the safety of residents in homes with life-safety concerns. This form is typically used by HCS program providers to request a life safety inspection for a specific residence.

The form requires essential information such as the provider's contact details, the address and type of residence to be inspected, and the level of evacuation capability and fire protection system status. Providers must also specify the reason for the requested inspection, which can include initial inspections, annual re-inspections, or re-inspections after a failed previous inspection.

Key features of this form include the required information listed above, as well as the option to attach supporting documentation. The form can be submitted via mail to the Texas Health and Human Services Commission's HCS Life Safety Inspection Survey Operations Architectural Unit or faxed to 512-438-4623. Providers can also email their request to [email protected].

• This form is used by HCS program providers to request life safety inspections for specific residences.
• The form requires essential information such as provider contact details, residence address and type, and level of evacuation capability and fire protection system status.