Form 1070, Offer of Texas Home Living Program

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Effective Date
04/2021
1070.pdf (111.64 KB)
1070-S.pdf (112.91 KB)

 

Instructions

Updated: 4/2021

 

Purpose

Form 1070 is used when a person is offered the opportunity to enroll in the Texas Home Living (TxHmL) program.

When to Prepare

The local intellectual and developmental disability authority (LIDDA) is responsible for completing this form and mailing it to the person or legally authorized representative after receiving notification from Texas Health and Human Services Commission to notify the person of the offer to enroll in TxHmL.

Transmittal

Form 1070 is mailed to the person or their legally authorized representative (LAR) via regular USPS mail.

Detailed Instructions

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

Person’s Name – Enter the person’s name as it appears in the Client Assignment and Registration (CARE) system.

Person’s Address – Enter the address of the person.

Date – Enter the date the form is being mailed.

Local Intellectual and Developmental Disability Authority (LIDDA) – Enter the LIDDA name.

LIDDA Address – Enter the LIDDA address.

LIDDA Staff Completing Form – Enter the name of the staff completing the form.

LIDDA Staff Area Code and Phone No. – Enter the phone number of the staff completing the form.

Required Response – In the first paragraph, enter the date that is 30 calendar days after the date of the form.

USPS Tracking No. (optional) – Enter the USPS tracking number. This is not required.