TX HHS Form 5830. Community-based Programs Access and Eligibility Services Contract Application Packet Checklist. State Office Enrolled

The TX HHS Form 5830, Community-based Programs Access and Eligibility Services Contract Application Packet Checklist, is a crucial document for entities seeking to establish a contract with the Texas Health and Human Services Commission (HHSC). This form helps ensure that all required forms and documents are submitted during the contract application process, streamlining the process and avoiding potential delays or denials.

This checklist outlines the necessary information and documentation required from applicants, including legal entity name, doing business as (DBA) if applicable, and various forms and agreements. Key features include the submission of required HHS forms, which can be downloaded from the Texas Health and Human Services website, and the retention of copies by applicants.

By utilizing this form, entities applying for a provisional contract with HHSC can avoid common pitfalls and ensure a smoother application process. The following key points should be noted:

• This form is intended for contract applicants and HHSC staff to ensure all required forms and documents are submitted.
• Required HHS forms must be downloaded from the Texas Health and Human Services website unless an exception is requested and approved.
• Failure to submit all required forms and documents will delay the contract application process and may result in HHSC denying the application.