Informacion en espanol = form also available in Spanish.

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 Informacion en espanol
1050 Nursing Facility or Crisis Diversion Plan  
1051 Request for Determination of Intellectual Disability for an Individual Referred for Guardianship by DFPS  
1052 Public Provider Choice Request Informacion en espanol
1058 Request for Home and Community-based Services Crisis Diversion Slot  
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 Informacion en espanol
1581 Consumer Directed Services (CDS) Option Overview Informacion en espanol
1582 Consumer Directed Services Responsibilities Informacion en espanol
1586 Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option Informacion en espanol
1595 Billing Resolutions Request  
2060-B Needs Assessment Addendum Informacion en espanol
2260 Permanency Planning Instrument (PPI) for Children Under 22 Years of Age (Family Directed Plan) Informacion en espanol
3608 Individual Plan of Care (IPC) – HCS/CFC Informacion en espanol
5842 TxHmL Financial Eligibility Information  
8001 Medicaid Estate Recovery Program Receipt Acknowledgement Informacion en espanol
8510 HCS/TxHmL CFC PAS/HAB Assessment  
8511 Understanding Program Eligibility and Services Informacion en espanol
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 Informacion en espanol
8592 Deadline Notification Informacion en espanol
8601 Verification of Freedom of Choice Informacion en espanol
8630 Continuity of Care  
8647 Service Coordination Assessment -- Intellectual Disability Services  
8648 Identification of Preferences Informacion en espanol
8654 State Supported Living Center (SSLC) Admission Application  
8662 Related Conditions Eligibility Screening Instrument  
8665 Person-Directed Plan Informacion en espanol
8665-ID Individual Data  
H1003 Appointment of an Authorized Representative Informacion en espanol
H1200 Application for Assistance – Your Texas Benefits Informacion en espanol
H1746-A MEPD Referral Cover Sheet  
H6516 Community First Choice Assessment Informacion en espanol
SSA-1020 Application for Extra Help with Medicare Prescription Drug Plan Costs