Form LIC 9182. Criminal Background Clearance Transfer Request - California
The Criminal Background Clearance Transfer Request (Form LIC 9182) is used when an individual who already holds an active criminal record clearance in California needs to transfer that clearance from one licensed facility, organization, or home to another.
TX HHS Form 2993. General Residential Operations Medication Log
The GRO Medication Log (Form 2993) is a mandatory record used in Texas residential childcare operations to track every prescription, nonprescription medication, and supplement administered to a child.
TX HHS Form 8617. Individualized Skills and Socialization Enhanced Staffing Rate
Form 8617 is used within the Texas Intellectual and Developmental Disabilities (IDD) waiver programs to request an Enhanced Staffing Rate for an individual who requires more support than the standard service level provides.
TX HHS Form 2760. Controlling Person Child Care Regulation
Form 2760 is used in Texas child care regulation to identify every “controlling person” connected with a child care operation. The state takes this information seriously because controlling persons can affect the health, safety, and overall management of children in care.
TX HHS Form 3050. DAHS Health Assessment or Individual Service Plan
Form 3050 is a core medical and functional assessment used in Texas Day Activity and Health Services (DAHS) programs. The form helps a DAHS nurse document a participant’s physical condition, cognitive abilities, daily care needs, and the specific supports that the facility will provide.
TX HHS Form H4100. Money Receipt
This document is a standardized receipt used by the Texas Health and Human Services Commission (HHSC) to record payments made toward a client’s account.
TX HHS Form 2551. Licensed and Registered Home: Caregivers. Assistants. Substitutes and Household Members Information Record
Form 2551 is a personnel information record required for licensed and registered child care homes in Texas.
TX HHS Form 7239. Incident or Illness Report
Form 7239 is used by Texas child-care operations to document injuries, the onset of illnesses, and reportable incidents involving a child.
TX HHS Form 3034. Provider Assessment Form
Form 3034, the Children with Special Health Care Needs (CSHCN) Provider Assessment Form, is a key medical evaluation document used in Texas to determine whether a child or qualifying individual meets the medical eligibility criteria for the CSHCN Services Program.
TX HHS Form 2985. Affidavit for Applicants for Employment with a Licensed Operation or Registered Child-Care Home
This affidavit is a mandatory disclosure form required from anyone seeking temporary or permanent employment in a licensed child care facility, child-placing agency, or registered child-care home.