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 Last updated
Form 2307, Rights and Responsibilities ES January 18, 2023
Form 2960, Application for a License to Operate a Residential Child Care Facility January 17, 2023
Form 4207, Individualized Family Service Plan (IFSP) Services ES January 17, 2023
Form 4801, State Fair Hearing Evidence Packet Cover Page ES January 13, 2023
Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order January 3, 2023
Form 2971, Child Care Regulation Request for Background Check ES December 14, 2022
Form 2870, Permission to Disclose Protected Health and Other Confidential Information November 28, 2022
Form 4121, Home and Community-based Services/Texas Home Living Community First Choice Personal Assistance Services/Habilitation ES November 28, 2022
Form 2806, Authorization of Youth Empowerment Services (YES) Waiver Services ES November 14, 2022
Form 4214, Request for Non-Emergency Medical Transportation (NEMT) Services November 8, 2022
Form 2407, Informal Dispute Resolution (IDR) Request October 21, 2022
Form 2361, PASRR Specialized Services Fair Hearing Request October 19, 2022
Form 2125, Home and Community-based Service (HCS), Texas Home Living (TxHmL) and Community First Choice (CFC) Implementation Plan October 19, 2022
Form 2442, Notification of Interest List Release Closure ES October 12, 2022
Medical Power of Attorney (MPOA) ES October 5, 2022