TX HHS Form 8509. Unlicensed Personnel Tracking of Delegated Tasks
Form 8509 is used in healthcare settings to document tasks that a Registered Nurse (RN) delegates to unlicensed personnel.
TX HHS Form 4004. Residential Child Care Licensing Environment Health Checklist
The Residential Child Care Licensing Environmental Health Checklist for Foster Homes (Form 4004) is designed to ensure that foster family homes in Texas meet the environmental health and safety standards set by the Texas Health and Human Services Commission (HHSC).
TX HHS Form 5503-MA. Verification of Curriculum by an Accredited School of Nursing
The Form 5503-MA, Medication Aide Program Verification of Curriculum, is used by the Texas Health and Human Services Commission (HHSC) to verify that the courses completed by a medication aide applicant meet the curriculum requirements specified in TAC 557.107(c)(2).
TX HHS Form 2960 Attachment C. CCR Application for a License to Operate a Residential Child Care Facility
Form 2960 Attachment C is a required supplement to the application for operating a general residential operation (GRO) in Texas that provides treatment services to children with emotional disorders.
TX HHS Form 2960 Attachment B. CCR Application for a License to Operate a Residential Child Care Facility
Form 2960 Attachment B is an essential guide for applicants seeking a license to operate a Residential Child Care Facility (RCCF) in Texas.
TX HHS Form 2960 Attachment A. CCR Application for a License to Operate a Residential Child Care Facility
Form 2960 Attachment A is a detailed checklist used in Texas when applying for a license to operate a General Residential Operation (GRO).
TX HHS Form H1854. Affidavit for Unauthorized Use of Electronic Benefit Transfer (EBT) Benefits
This form is used when a SNAP household in Texas discovers that someone has accessed and spent their EBT (Lone Star Card) benefits without permission. It is an official affidavit required by the Texas Health and Human Services Commission (HHSC) before replacement benefits can be considered.
TX HHS Form 3262. Licensed Chemical Dependency Counselor Intern Supervised Work Experience Documentation
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.
TX HHS Form 3599. Habilitation Service Provider Orientation/Supervisory Visits
Texas Form 3599 is an official document used by providers within the Texas Health and Human Services Commission (HHSC) programs, specifically CLASS (Community Living Assistance and Support Services) and CFC (Community First Choice).
TX HHS Form 1582. Consumer Directed Services Responsibilities
Form 1582 explains the core responsibilities of everyone involved in the Consumer Directed Services (CDS) option in Texas. Unlike agency-based care, CDS gives an individual (or their legally authorized representative) the authority to hire, train, and supervise their own service providers.