TX HHS Form 8577. Questionnaire for LTSS Waiver Program Interest Lists

The TX HHS Form 8577, Questionnaire for LTSS Waiver Program Interest Lists, is a crucial tool used to express interest in the Long-Term Services and Supports (LTSS) Waiver program. This form helps individuals or their representatives identify potential eligibility for LTSS waiver services, which provide essential support when a funded slot becomes available.

This questionnaire requires key information about the individual seeking LTSS waiver services, including their name, date of birth, social security number, and mailing address. Additionally, it asks for primary and secondary contact details, as well as alternate contacts if applicable. The form also inquires about conservatorship status with Child Protective Services (CPS) or Adult Protective Services (APS), if relevant.

The TX HHS Form 8577 is designed to be completed by the individual or their representative, providing a comprehensive overview of their interest in LTSS waiver services. This form should be used when an individual is considering applying for LTSS waiver services and needs to express their interest. By completing this questionnaire, individuals can initiate the process of determining eligibility for these vital services.