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 ensure the safety of residents in homes or dwellings. This form should be used by program providers who need to request a life safety inspection for a specific residence.

This form requires key information from the provider, including their contact details and the address of the residence to be inspected. The type of inspection requested is also crucial, with options ranging from initial inspections to reinspections after a failed previous inspection. Providers must also indicate whether the home has a fire protection system in place, such as fire sprinklers.

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. Electronic submissions are also possible through email at [email protected]. By completing this form, program providers can ensure that their residents' homes meet essential life safety standards.