TX HHS Form 6000. Children's Autism Program Enrollment

The TX HHS Form 6000, "Children's Autism Program Enrollment", is a crucial document for families seeking to enroll their children in the Children's Autism Program. This form helps parents or guardians provide essential information about their child, household income, insurance coverage, and previous Early Childhood Intervention (ECI) services.

The form requires family information, including the child's first name, middle name, birth date, parent or guardian's name, and relationship to the child. Additionally, it asks for income details, such as gross income, allowable deductions, and adjusted gross income. The form also inquires about insurance coverage, including CHIP, Medicaid, Medicare, and private insurance.

This form should be used when a family is seeking enrollment in the Children's Autism Program. It is essential to complete this form accurately and truthfully, as it serves as an application for program services. The form includes a certification statement, which must be signed by the parent or guardian, guardian, or caretaker, indicating that the information provided is true and correct to the best of their knowledge.