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 3595, IPP Service Review
Form 3591, CLASS IPC/IDRC Cover Sheet
Form 2076, Authorization to Release Medical Information ES
Form 1739, Service Provider Agreement ES
Form 1351, Request to Withdraw from the CLASS Application Process ES
Form 1041, Refusal of PASRR Mental Illness Specialized Services ES
Form H4808, Notice of Change in Applied Income/Notice of Denial of Medical Assistance
Form 3074, Physician Certification of Terminal Illness ES
Form 3071, Individual Election, Cancellation or Update ES
Form 8648, Identification of Preferences ES
Form 8630, Local Intellectual and Developmental Disability Authority (LIDDA) Continuity of Care
Form 8592, Deadline Notification ES
Form 8590, Request for Approval to Withdraw an Enrollment Offer
Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC
Form 8571, Request to Change Interest List Information for Home 
and Community-based Services (HCS) or Texas Home Living (TxHmL)