Form 3239, Initial Licensed Sex Offender Treatment Provider or Affiliate Sex Offender Treatment Provider Licensure Application

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Documents

Effective Date: 10/2022

Instructions

Updated: 10/2022

Purpose

Form 3239 is used to apply for an Initial Licensed Sex Offender Treatment Provider (LSOTP) or Affiliate Sex Offender Treatment Provider (ASOTP) license. 

Additional information regarding licensure, including the Council on Sex Offender Treatment contact information, is located on the CSOT webpage.

Procedure

When to Prepare

An applicant must submit the application, fees and other documents and complete all actions as required by Texas Administrative Code Title 22 (22 TAC), Chapter 810, Council on Sex Offender Treatment, Section  810.3, License Required. The Texas Health and Human Services Commission (HHSC) will not process an application until after HHSC Accounts Receivable receives and posts the license fee.

HHSC and CSOT must approve all required application materials received before HHSC will issue a license to the applicant.

LSOTP Applicants

An LSOTP applicant must meet all eligibility criteria under 22 TAC Section 810.3(c)(1), including the following:

  • Hold one of the following medical or mental health licenses, as defined by 22 TAC Section 810.2(12), and provide treatment to sex offenders, juveniles who commit sexual offenses, or both:
    • physician;
    • psychiatrist;
    • psychologist;
    • psychological associate;
    • provisionally licensed psychologist;
    • licensed professional counselor;
    • licensed professional counselor intern;
    • licensed marriage and family therapist;
    • licensed marriage and family associate;
    • licensed clinical social worker;
    • licensed master social worker under a Texas State Board of Social Work Examiners' approved clinical supervision plan;
    • Advanced practice registered nurse recognized as a psychiatric clinical nurse specialist; or
    • psychiatric mental health nurse practitioner;
  • possess a minimum of 1,000 documented and verified hours of clinical experience while under the supervision of a CSOT-approved supervisor in the areas of assessment and treatment of sex offenders that the applicant obtained within the past seven-year period; and
  • possess a minimum of 40 documented continuing education hours in sex offender assessment and treatment that the applicant obtained within three years before the application date:
    • Of the initial 40 hours of required training, 30 hours must be in sex offender assessment and treatment and 10 hours must be in sexual assault victim related training.
    • Continuing education activities must be instructor-directed activities such as conferences, symposia, seminars and workshops. 

An LSOTP applicant must complete the following requirements.

  • Submit the following to HHSC:
    • a completed Form 3239;
    • a completed Application Questionnaire Addendum (included with Form 3239), as required by 22 TAC Section 810.3(c)(1)(C);
    • a nonrefundable license fee of $375.00, as required by 22 TAC Section 810.5(a)(1);
    • a copy of the applicant’s primary medical or mental health license indicating the applicant's license is current and in good standing in accordance with 22 TAC Section 810.3(c)(1)(F);
    • a reference letter from an LSOTP who has actual knowledge of the applicant's clinical work in sex offender assessment and treatment; and
    • continuing education certificates that document the applicant meets the eligibility training requirements under 22 TAC Section 810.3(c)(1)(B); and
  • Complete criminal background checks conducted by the Texas Department of Public Safety and the Federal Bureau of Investigation unless the applicant meets the requirements to substitute an employer certification under 22 TAC Section 810.34(b).

ASOTP Applicants

An ASOTP applicant must meet all eligibility criteria under 22 TAC Section 810.3(c)(2), including the following:

  • Hold one of the following medical or mental health licenses, as defined by 22 TAC Section 810.2(12), and provide treatment to sex offenders, juveniles who commit sexual offenses, or both:
    • physician;
    • psychiatrist;
    • psychologist;
    • psychological associate;
    • provisionally licensed psychologist;
    • licensed professional counselor;
    • licensed professional counselor intern;
    • licensed marriage and family therapist;
    • licensed marriage and family associate;
    • licensed clinical social worker;
    • licensed master social worker under a Texas State Board of Social Work Examiners' approved clinical supervision plan;
    • advanced practice registered nurse recognized as a psychiatric clinical nurse specialist; or 
    • psychiatric mental health nurse practitioner; and
  • Be supervised by an LSOTP in accordance with 22 TAC Section 810.3(c)(8)(A)-(D) until obtaining LSOTP status.

An ASOTP applicant must complete the following requirements.

  • Submit the following to HHSC:
    • a completed Form 3239;
    • a nonrefundable license fee of $375.00, as required by 22 TAC Section 810.5(a)(1);
    • a copy of the applicant’s primary medical or mental health license in accordance with 22 TAC Section 810.3;
    • a reference letter from an LSOTP who has actual knowledge of the applicant's clinical work in sex offender assessment and treatment; and
    • a completed contract of supervision, designating an LSOTP as a supervisor and a copy of the LSOTP supervisor's license indicating the supervisor's license is current and in good standing; and
  • complete criminal background checks conducted by the Texas Department of Public Safety and the Federal Bureau of Investigation unless the applicant meets the requirements to substitute an employer certification under 22 TAC 810.34(b).

Important Items to Note:

  • Fingerprint Applicant Services of Texas (FAST) processes fingerprints for the required background checks and both criminal histories will be completed from this process.
  • Once HHSC receives an application, HHSC will send a letter to the applicant with instructions to only submit the receipt to HHSC. Do not submit a fingerprint card.
  • CSOT does not accept online continuing education courses. CSOT must pre-approve courses an applicant takes at an institution of higher learning. CSOT will only accept continuing education hours that are specific to sex offender assessment and treatment and sexual assault victim related training.
  • Applicants must complete all required items in the application process within 90 days after HHSC receives their application in accordance with 22 TAC Section 810.3.

Mailing Address for Applications with Fees:

Submit a check, money order, or cashier’s check made payable to Texas Health and Human Services in the amount of $375.00. Fees paid are non-refundable.

Mail the fee along with a copy of your application to:

HHSC Accounts Receivable
P.O. Box 149055
Mail Code 1470
Austin, Texas 78714-9055