Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

    Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

    If still having trouble viewing or downloading a form, click here.

Effective Date: 



Updated: 2/2012


Form 0702 is to be used as the fax cover sheet when submitting Texas Home Living (TxHmL)/Home and Community-based Services (HCS) Transfer, Continuation of Suspension or Termination requests. The service coordinator at the Local Authority (LA) includes Form 0702 when faxing requests to the Texas Health and Human Services Commission (HHSC), Utilization Management and Review, IDD Waivers Program Enrollment/Utilization Review (PE/UR) unit for an individual's transfer, continued suspension or termination.

Important: Do not fax a request until after all of the data entry screens have been completed in the Client Assignment and REgistration (CARE) System, unless requested by HHSC.

Detailed Instructions

Date — Enter the date.

No. of pages (including cover sheet) — Enter the total number of pages included in the fax, including the cover sheet.

To and Fax No. — Enter the name of the individual at HHSC PE who is to receive the fax, and the recipient's area code and fax number.

From and Fax No. — Enter the sender's name, area code and fax number.

Email and Telephone No. — Enter the sender's email address, and the sender's area code and telephone number.

Local Authority (LA) and LA Component Code — Enter the name of the LA and its component code.

Check the appropriate box below — Check the box that indicates the type of request and ensure that all supporting documentation is included in the fax.

Transfer of Waiver Program Services (must include):

  1. Form 3617, Request for Transfer of Waiver Program Services; and
  2. Form 3608, Individual Plan of Care – Home and Community-based Services, OR Form 8582, Individual Plan of Care – TxHmL.

Continue Suspension of Waiver Program Services (must include):

  1. Form 3615, Request to Continue Suspension of Waiver Program Services; and
  2. Items listed in the “Required Documentation” section of the form.

Termination of Waiver Services (must include):

  1. Form 3616, Request for Termination of Waiver Program Services;
  2. Discharge meeting notes signed and dated by all meeting attendees; and
  3. 90-day, 180-day and 270-day review notes, if applicable.

Other (enter a description): — Self-explanatory.