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Effective Date: 
4/2017

Documents

Instructions

Updated: 4/2017

Purpose

The Children’s Autism Program service providers use Form 6001 to submit requested changes to their “key personnel” to the Texas Health and Human Services Commission (HHSC).

Completed Form

Send the completed form to Joan Cooksey at Joan.Cooksey@hhsc.state.tx.us. Attach an explanation of the circumstances of the proposed changes as well as the key personnel member’s current resume.

Form Retention

Internal HHSC users: In most cases, the original version of completed forms must be maintained in accordance with federal and state laws and HHSC policy. If you are unsure how long to maintain a given form, consult the HHSC Records Retention Schedule or HHSC Records Management Office.

Providers and contractors: The original version of completed forms must be maintained in accordance with federal and state laws, HHSC policy, and your contract with HHSC. If you have any questions, contact your contract manager.

Consumers: You may maintain a copy of the form for your own records if you choose.