Form 6001, Children's Autism Program Key Personnel Change Request

Instructions for Opening a Form: Some forms cannot be viewed in a web browser's PDF viewer and must be opened in the Adobe Reader application on your desktop system. Click here for instructions on opening this form.

Effective Date

9/2024
6001.pdf

Instructions

Updated: 9/2024

Purpose

The Children’s Autism Program service providers use Form 6001 to submit requested changes to their key personnel to the Texas Health and Human Services Commission (HHSC).

Completed Form

Email the completed form to Children’s Autism Program. Attach an explanation of the circumstances for the proposed changes and the key personnel member’s current resume.

Form Retention

Internal HHSC users: In most cases, the original version of completed forms must be maintained per federal and state laws and HHSC policy. Contact the HHSC Records Retention Schedule or HHSC Records Management Office if you are unsure about how long to maintain a given form.

Providers and contractors: The original version of completed forms must be maintained per federal and state laws, HHSC policy, and your contract with HHSC. Contact your contract manager if you have any questions.