TX HHS Form 1730. Wage and Benefits Plan Employee Compensation
Form 1730 is a document used in Consumer Directed Services programs to outline and agree upon an employee's compensation, benefits, and withholdings. It ensures clear documentation of wage details, optional benefits, and financial agreements between the employee and employer.
TX HHS Form 3029. Application for Program Benefits
The Application for Program Benefits (Form 3029) is a comprehensive form designed to streamline access to essential health care services for low-income individuals and families in Texas.
TX HHS Form 3243. Affiliate Sex Offender Treatment Provider or Licensed Sex Offender Treatment Provider Name Change or Duplicate License Application
Form 3243 is an official application used by licensed professionals in the field of sex offender treatment in Texas to request a name change on their license or to obtain duplicate copies of their license and renewal cards.
TX HHS Form 0020. External Entity Information Security Risk Exception Request
Form 0020 serves as a formal mechanism for external entities contracted with Texas Health and Human Services (HHS) to request exceptions for security requirements they cannot meet.
TX HHS Form 3622. Denial of Application for CLASS
Form 3622 serves as an official notification from the Texas Health and Human Services Commission (HHSC) informing individuals that their application for enrollment in the Community Living Assistance and Support Services (CLASS) Program has been denied.
TX HHS Form 7271. Personnel Records Evaluation LCCH/RCCH
Form 7271, titled "Personnel Records Evaluation LCCH/RCCH," is a standardized checklist used by the State of Texas to assess the personnel files of individuals working in or associated with licensed and registered child care homes.
TX HHS Form 5871. Disclosure of Ownership and Control Statement
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).
TX HHS Form 1046. Request for HCS Adult NF Transition Slot
Form 1046 is a standardized document used by Local Intellectual and Developmental Disability Authorities (LIDDAs) in Texas to request a Home and Community-based Services (HCS) Adult Nursing Facility (NF) Transition Slot for an eligible individual.
TX HHS Form 8584-CDS. Comprehensive Nursing Assessment and Plan of Care HCS Program
Form 8584-CDS is a comprehensive nursing assessment and plan of care used in the Consumer Directed Services (CDS) option of the Home and Community-based Services (HCS) program.
TX HHS Form 5523. Medication Aide Experience Documentation Report
Form 5523 (June 2024) is used by the Medication Aide Program to verify an applicant’s employment history and hands-on experience in qualifying health care settings.