TX HHS Form 5916. Applicant/Contractor Screening Criteria

The TX HHS Form 5916, Applicant/Contractor Screening Criteria, is a crucial document used to screen applicants or contractors for various purposes. This form helps ensure that entities meet specific criteria before being enrolled or re-enrolled in a program or undergoing formal or intermittent monitoring.

This screening process typically involves providing essential information about the legal entity, including its name, doing business as (DBA) if applicable, and identification numbers such as the Texas Identification Number (TIN), Federal Taxpayer Identification Number (EIN or SSN), and National Provider Identifier (NPI). The form also inquires about the type of legal entity, contract number, and contract type.

The form is designed to accommodate various scenarios, including changes in ownership interest, change of ownership or legal entity, and other circumstances. It explicitly notes that certain questions are not applicable for specific types of entities, such as sole proprietors, general partnerships, hospital districts or authorities, governmental entities, and institutions of higher education. By completing this form, applicants or contractors can demonstrate their compliance with the necessary screening criteria.