ES = Spanish version available.

Form Title  
1019 Opportunity to Register to Vote/Declination  
1040 CFC Non-Waiver Packet Information and Checklist  
1042 Pre-Move Site Review  
1043 Post-Move Monitoring  
1045 HCS/TxHmL Request for Enrollment Extension  
1049 Initial Documentation of Provider Choice ES
1050 Nursing Facility or Crisis Diversion Plan  
1051 Request for Determination of Intellectual Disability (DID)  
1052 Public Provider Choice Request ES
1058 Request for Home and Community-based Services Crisis Diversion Slot  
1067 Offer of Home and Community-based Services (HCS) Program ES
1068 Withdrawal of Offer for Home and Community-based Services (HCS) Program ES
1570 ICF Request for Medical Need Assessment or Verification of RUG-III Category  
1580-IDD Texas Money Follows the Person Demonstration (MFPD) Project Agreement of Participation ES
1581 Consumer Directed Services (CDS) Option Overview ES
1582 Consumer Directed Services Responsibilities ES
1586 Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option ES
1595 Billing Resolutions Request  
2060-B Needs Assessment Addendum ES
2260 Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan) ES
3608 Individual Plan of Care (IPC) – HCS/CFC ES
5842 TxHmL Financial Eligibility Information  
8001 Medicaid Estate Recovery Program Receipt Acknowledgement ES
8510 HCS/TxHmL CFC PAS/HAB Assessment  
8511 Understanding Program Eligibility and Services ES
8571 Request to Change Interest List Information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL)  
8577 Questionnaire for LTSS Waiver Program Interest Lists  
8578 Intellectual Disability/Related Condition Assessment  
8578-CFC Intellectual Disability/Related Condition Assessment for CFC  
8582 Individual Plan of Care – TxHmL/CFC  
8586 TxHmL Service Coordination Notification ES
8592 Deadline Notification ES
8601 Verification of Freedom of Choice ES
8630 Continuity of Care  
8647 Service Coordination Assessment  
8648 Identification of Preferences ES
8654 State Supported Living Center (SSLC) Admission Application  
8662 Related Conditions Eligibility Screening Instrument  
8665 Person-Directed Plan ES
8665-ID Individual Data  
H1003 Appointment of an Authorized Representative ES
H1200 Application for Assistance – Your Texas Benefits ES
H1746-A MEPD Referral Cover Sheet  
H6516 Community First Choice Assessment ES
SSA-1020 Application for Extra Help with Medicare Prescription Drug Plan Costs