Form 3926, Change of Disability

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Documents

Effective Date: 5/2021

 

Instructions

Updated: 5/2017

 

Use

Form 3926 is sent to the certifier who certified an applicant's  Form 3907, Application for Specialized Telecommunications Assistance Program (STAP) Speech Generating Devices, for a specialized device for telephone access after Office of Deaf and Hard of Hearing Services (DHHS) staff members determine that a supplemental voucher must be issued.

Copies and Distribution

Once the form is completed by the certifier, it is mailed to STAP, P.O. Box 12607, Austin, Texas 78711. For interagency mail, the Mail Code is 3027. One copy is maintained in the STAP program area within DHHS.

Retention

The original form is retained by DHHS. The retention for the form is between one and five years, depending on the outcome of the application process and as required by the Texas Health and Human Services (HHS) retention schedule.

Detailed Instructions

The Applicant Information section is completed by DHHS. The remaining sections are completed by the certifier.

Acronyms and Definitions

STAP—Specialized Telecommunications Assistance Program