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Effective Date: 
4/2017

Documents

 

Instructions

Updated: 4/2017

 

Purpose

Form 4202 explains the contractor’s rights and responsibilities for any adverse action taken on behalf of the Texas Health and Human Services Commission (HHSC).

 

Copies and Distribution

HHSC staff must attach a copy of this form to any notice of adverse action, and

  • send the original notice of adverse action and attached Form 4202 to the contractor,
  • retain a copy for the contract files, and
  • forward to the HHSC Contract Administration Manager:
    • a copy of this form,
    • the notice of adverse action, and
    • any documentation related to the notice of adverse action.

 

Retention

The staff retains a copy of this form, the notice of adverse action, and any documents related to the notice of adverse action according to the current HHSC record retention schedule.

 

Detailed Instructions

Form 4202 must not be changed or amended in any way.