Texas

Form 5873 is an official checklist used in Texas during the application process for provisional contracts under Waiver and Community-based Programs and Services for Medicaid and CHIP. This document helps both applicants and Texas Health and Human Services Commission (HHSC) staff confirm that all required forms and supporting documents are included before a contract application is reviewed.

The TX HHS Form 5872, Certification of Pre-Application Orientation, is a crucial document that helps solve the problem of ensuring providers have completed necessary orientation requirements for various services. This form is typically used in situations where providers are contracting to offer services such as Community Living Assistance and Support Services (CLASS), Day Activity and Health Services (DAHS), or Primary Home Care/Family Care/Community Attendant Services (PHC/FC/CAS).

Form 5871, Section 9, is a legally binding certification document used by entities seeking to enroll in the Texas Medicaid program or to secure a community services contract with the Texas Health and Human Services Commission (HHSC). This section is not a standalone form but a critical, concluding part of a larger application packet. Its primary function is to formalize the applicant's attestation to the truthfulness and completeness of the information provided throughout the entire application process.

The TxHmL Financial Eligibility Information Form (Form 5842) helps determine the financial eligibility status of applicants for the Texas Home Living (TxHmL) Program. This form is typically used by the Local Intellectual and Developmental Disability Authority (LIDDA) to assess an applicant's financial situation and make a determination about their eligibility for the program.

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

The TX HHS Form 5830, Community-based Programs Access and Eligibility Services Contract Application Packet Checklist, is a crucial document for entities seeking to establish a contract with the Texas Health and Human Services Commission (HHSC). This form helps ensure that all required forms and documents are submitted during the contract application process, streamlining the process and avoiding potential delays or denials.

The TX HHS Form 5606, Life Safety Code Certification, is a crucial document that helps ensure the safety of residents in Texas. This form is typically filled out by a representative of the fire safety authority having jurisdiction for a specific address, certifying that the residence complies with applicable portions of the National Fire Protection Association (NFPA) 101: Life Safety Code (LSC) or International Fire Code (IFC).

The TX HHS Form 5605, Life Safety Code Overview Worksheet, is a practical tool designed to help reviewers determine whether a home meets the requirements of the National Fire Protection Association (NFPA) 101 Life Safety Code (LSC). This worksheet is typically used by reviewers when a home does not have a current inspection from the local fire marshal.

The TX HHS Form 5604, HCS Program Provider Request for Life Safety Inspection, is a crucial document that helps solve the problem of ensuring the safety of residents in homes with life-safety concerns. This form is typically used by HCS program providers to request a life safety inspection for a specific residence.

Form 5541 serves as the enrollment application for the Corrections Medication Aide Program administered by the Texas Health and Human Services Commission (HHSC). This form is essential for individuals aiming to train and become certified as medication aides specifically in correctional settings, ensuring they can safely administer medications under regulated guidelines.