Forms

HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

ES = Spanish version available.

Title
Form 5497, NATCEP – Texas Nurse Aide Performance Record
Form 5513, NATCEP – Request to Take the Competency Evaluation Program (CEP) Based on Competency in Basic Nursing
Form 5511, NATCEP – Request to Take the Competency Evaluation Program Based on Military Training as a Nurse Aide
Form 5510, NATCEP – Request to Take the Competency Evaluation Program (CEP) Based on Approved Nurse Aide Training Out of State
Form 6325, Home and Community Support Services Agency – Medicare Certified Agency Relocation Questionnaire
Form 3906, Application for Specialized Telecommunications Assistance Program ES
Form 1019, Opportunity to Register to Vote/Declination ES
Form 2307, Rights and Responsibilities ES
Form LSC, Lone Star Card
Form 2279, Request for Service Waiver
Form 8618, State Long-Term Care Ombudsman Program Initial Certification Training Log
Form 3625, CLASS and CFC Documentation of Services Delivered ES
Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement ES
Form 5006, Application for Hardship Waiver ES
Form 8004, Medicaid Estate Recovery Program (MERP) Authorization and Certification