TX HHS Form 5831. Community-based Programs Access and Eligibility Services Contract Application Packet Checklist. Regionally Enrolled

The TX HHS Form 5831, Community-based Programs Access and Eligibility Services Contract Application Packet Checklist, Regionally Enrolled, is a crucial document for entities seeking to contract with the Texas Health and Human Services Commission (HHSC) for community-based programs. This form helps ensure that all required forms and documents are submitted during the contract application process, streamlining the process and preventing delays or denials.

This checklist outlines the necessary forms and documents that must be submitted, including the Designation of Authorized Individual(s), Community Services Contract Application, Written Acknowledgement of Completion of Cybersecurity Training Program, and more. The form also highlights important sections, such as Section 1: Required Forms and Documents, which includes Ferm 2031, Form 3681, and others. Additionally, applicants must submit a copy of Verification of the Employer Identification Number (EIN) and National Provider Identifier (NPI) confirmation email or letter, if applicable.

The TX HHS Form 5831 is intended for contract applicants and HHSC staff to ensure all required forms and documents are submitted during the contract application process. It is essential to carefully read the instructions before completing the form to avoid errors and omissions that may delay the application process. The form can be downloaded from the Texas Health and Human Services (HHS) Internet forms website at https://hhs.texas.gov/laws-regulations/forms.