TX HHS Form 8491. Request for a Four-Person Residence Approval

The TX HHS Form 8491, Request for a Four-Person Residence Approval, is a crucial document for Home and Community-based Services (HCS) providers in Texas. This form helps solve the problem of obtaining approval for four-person residences, which are subject to specific regulations and requirements.

To request approval, providers must submit a Provider Location Update (PLU) by email to the Texas Health and Human Services Commission (HHSC). The form requires key information such as the residence address, county of residence, and contact person details. Providers must also certify that they intend to provide residential support to one or more individuals who will live in the residence, and that the residence meets specific certification standards.

The approved four-person residence is subject to ongoing responsibilities, including obtaining annual fire marshal certifications, maintaining current certification, and keeping a copy of the certification on site. HHSC will notify providers via email or phone of the status and provide a copy of the Form 9010 Approval letter or Form 9012 Denial letter. Key points to note:

• Providers must request and obtain approval for all four-person residences.
• The form requires certification that the residence meets specific standards.
• Ongoing responsibilities include obtaining annual fire marshal certifications and maintaining current certification.