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.
TX HHS Form 2935. Admission Information
Form 2935 is used in Texas child care facilities to collect essential information about a child before enrollment. Parents or guardians must complete this form and return it to the day care provider prior to the child’s first day.
TX HHS Form 3681. Community Services Contract Application
Form 3681 is used in Texas to apply for or update a Community Services Contract with the Health and Human Services Commission (HHSC).
Certificate of Substantial Completion (AIA G704)
The Certificate of Substantial Completion (AIA G704) is an official construction industry document issued to declare that a project is sufficiently completed and ready for its intended use.
Ohio Bureau of Motor Vehicles (BMV) Forms
The Ohio Bureau of Motor Vehicles (BMV) provides a comprehensive range of forms to accommodate various needs and circumstances related to vehicle ownership, insurance, legal documentation, and more.
TX HHS Form H4831. Fraud Referral Log
The TX HHS Form H4831, Fraud Referral Log, is a practical tool designed to facilitate the reporting of suspected fraud cases. This form helps solve the problem of tracking and documenting fraudulent activities, allowing for swift and effective action to be taken.
TX HHS Form H4833. Appeals Information
The TX HHS Form H4833, Appeals Information, helps individuals navigate the appeals process for denied benefits or services.