Form 3236 is the official application used to request a Texas Licensed Chemical Dependency Counselor (LCDC) license through reciprocity. It allows counselors who already hold a qualifying credential in another jurisdiction to apply for Texas licensure through the Health and Human Services Commission (HHSC), provided they meet education, credential, and regulatory requirements.
Form 3225 is an official supplemental document used as part of the Clinical Laboratory Improvement Amendments (CLIA) certification process in the United States. This form is completed in addition to CMS Form 116 and focuses specifically on disclosure of ownership and control for clinical laboratories seeking CLIA certification or maintaining their existing certification.
Its primary purpose is to ensure transparency regarding who owns, controls, or has a significant financial interest in a laboratory that performs clinical testing on human specimens.
Form 3248 is the official application used in Texas to register as a Chemical Dependency Counselor Intern (CI). This document is required for individuals who are beginning the process of becoming a Licensed Chemical Dependency Counselor (LCDC) or who need to extend their existing intern registration. The form is issued and administered by the Texas Health and Human Services Commission (HHSC) and is governed by Texas Administrative Code (26 TAC), Chapter 562.
The LCDC License Application (Form 3266) is the final step for registered counselor interns in Texas who are ready to advance to full licensure. This form confirms that an applicant has completed all training, supervised work experience, educational requirements, and examinations required by the Texas Health and Human Services Commission (HHSC) under 26 TAC Chapter 562 and Texas Occupations Code Chapter 504.
Form 3262 is the official document used in Texas to verify and report the supervised work experience hours completed by a Licensed Chemical Dependency Counselor (LCDC) Intern. It is submitted directly to the Texas Health and Human Services Commission (HHSC) by a Clinical Training Institution (CTI) coordinator or a Certified Clinical Supervisor (CCS). This form plays a crucial role in transitioning an intern toward full LCDC licensure, making accuracy and regulatory compliance essential.
The TX HHS Form 3082, Notice of Ineligibility, is a crucial document for individuals who have applied for County Indigent Health Care Program (CIHCP) benefits but have been denied. This form serves as formal notification to the applicant, outlining the reasons for denial and providing information on the appeal process.
The TX HHS Form 3083, Optional Health Care Services Notification, is a crucial document that helps counties in Texas notify the state of their optional health care services. This form is typically used by county officials to indicate which health care services they choose to provide or discontinue for indigent clients.
The TX HHS Form 3084, Employment Verification, helps determine the eligibility of a household applying for health care assistance from the County Indigent Health Care Program (CIHCP). This form is used to verify all earnings of an individual who is, was, or will be employed by another person. Typically, this form is completed by employers who need to provide employment information to support their employee's application for healthcare benefits.
The TX HHS Form 3085, Statement of Self-Employment Income, is a crucial document for individuals who earn income through self-employment. This form helps solve the problem of accurately reporting self-employment income to the County Indigent Health Care Program (CIHCP). Typically, this form is used by self-employed individuals who need to provide proof of their income to the CIHCP.
The TX HHS Form 3087, TMHP Confidentiality Agreement, is a crucial document that ensures the confidentiality, integrity, and continuity of information resources for the County Indigent Health Care Program (CIHCP). This form is used to confirm the understanding and agreement among staff members regarding the handling of client-sensitive information accessed through the Automated Inquiry System (AIS) or Texas Medicaid & Healthcare Partnership (TMHP).
