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: 7/2019



Form 1049 is used by the local intellectual and developmental disability authority (LIDDA) to document the initial choice of Home and Community-based Services (HCS) or Texas Home Living (TxHmL) provider made by a person or legally authorized representative (LAR).


When to Prepare

Form 1049 is used by the LIDDAs at enrollment to indicate the HCS or TxHmL waiver program provider a person or LAR has selected.



LIDDA staff complete the form and keep it on file with the person’s enrollment paperwork. The LIDDA is not required to submit this form.


Detailed Instructions

Name of Local Intellectual and Developmental Disability Authority (LIDDA) – Enter the name of the LIDDA completing the enrollment.

Name of LIDDA Contact – Enter the LIDDA contact for this enrollment.

Area Code and Phone Number – Enter the LIDDA contact’s area code and phone number.


Section I, HCS or TxHmL Slot Information – Select HCS or TxHmL to indicate the waiver program offered to the person and enter the slot number.

Slot Tracking Number (If applicable) – Enter the number, if applicable.


Section II, Selected Provider’s Information

Legal Name of Provider – Enter the legal name of the chosen program provider.

Doing Business As – Enter the public name the program provider uses to conduct business.

Provider Contract Number – Enter the provider contract number.

Provider Component Code – Enter the provider component code.


Section III, Person’s Information Name of Person – Enter the first and last name of the person enrolling in the waiver program.

CARE ID – Enter the person’s Client Assignment and Registration (CARE) system identification number.


Section IV, Acknowledgement

Printed Name of Person or Legally Authorized Representative (LAR) – The person or LAR enters their first and last name.

Signature of Person or LAR – The person or LAR signs the form.

Date – The person or LAR enters the date the form was signed.

Printed Name and Title of LIDDA Representative – The LIDDA representative completing the form enters their first and last name and job title.

Signature of LIDDA Representative – The LIDDA representative signs the form.

Date – The LIDDA representative enters the date the form was signed.