Form 1067, Offer of Home and Community-based Services (HCS) Program

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Effective Date
10/2019
1067.pdf (111.27 KB)
1067-S.pdf (111.74 KB)

Instructions

Updated: 10/2019

Purpose

Form 1067 is used when a person’s name comes off the interest list and a slot is available for them to enroll in the Home and Community-based Services (HCS) Program.

When to Prepare

The Local Intellectual and Developmental Disability Authority (LIDDA) is responsible for using this form after receiving notification from Texas Health and Human Services Commission (HHSC) to notify the person of the offer to enroll.

Transmittal

Form 1067 is mailed to the person or their legally authorized representative (LAR) via USPS certified mail.

Instructions

The LIDDA is responsible for filling out all text boxes on the form and mailing it to the person.