Forms

HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

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ES = Spanish version available.

Title
Form 5990, Contract Monitoring Exit Conference
Form 4116-MHM-AA, Minor Home Modification and Adaptive Aids Summary Sheet
Form 3001, Independent Living Services Program Quarterly Financial Report
Form 3095, Home and Community-based Services Adult Mental Health (HCBS-AMH) Program Voluntary Referral Hold Request
Form 2040, CMPAS Copay Worksheet
Form 3266, Licensed Chemical Dependency Counselor (LCDC) License Application
Form 2186, Home and Community-based Service (HCS) and Texas Home Living (TxHmL) Implementation Plan for Individualized Skills and Socialization
Form 2125, HCS, TxHmL and CFC – Implementation Plan
Form 6520, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for the DBMD Program Service Provider Training
Form 6519, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for General Orientation Training
Form 6518, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for Person-Specific Training, Instructions
Form 3262, Licensed Chemical Dependency Counselor Intern Supervised Work Experience Documentation
Form 2260, Local Intellectual and Development Disability Authorities (LIDDAs) Permanency Planning Instrument (PPI) for Children Younger Than 22 Years, Family Directed Plan ES
Form H0050, Parent Profile Questionnaire ES
Form 1584, Consumer Participation Choice ES