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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 H2111, Interested List Notification – HCBS ES
Form H1173, EBT Card Issuance Log
Form 3048, Notice of Eligibility ES
Form 3244, Clinical Training Institution Application
Form 3238, Licensed Chemical Dependency Counselor or Counselor Intern Name Change or Duplicate License Application
Form 3237, Certified Clinical Supervisor Application
Form 3241, Ambulatory Surgical Center Annual Report
Form 3206, Chemical Dependency Treatment Facility Closure
Form 3598, Individual Transportation Plan
Form 3598-HCS-TxHmL, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Individual Transportation Plan
Form 3157, Base or Operational Grant Quarterly Financial Report and Analysis
Form 8496, HCBS-AMH Program On-Site Settings Assessment Tool
Form 3272, CSOT Contract of Supervision for Affiliate Sex Offender Treatment Provider
Form 3271, CSOT Licensed Sex Offender Treatment Provider Applicant Letter of Reference
Form 3270, CSOT Affiliate Sex Offender Treatment Provider Supervised Work Experience Documentation
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