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
Form 8571, Request to Change Interest List Information for Home  and Community-based Services (HCS) or Texas Home Living (TxHmL)
Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC
Form 8618, State Long-Term Care Ombudsman Program Initial Certification Training Log
Form 8665, Person-Directed Plan ES
Declaration for Mental Health Treatment (DMHT) ES
Form 8628, Acknowledgement of Ombudsman Access to Confidential Record
Form 8654, State Supported Living Center (SSLC) Admission Application
Medical Power of Attorney Designation of Health Care Agent (MPOA) ES
Directive to Physicians and Family or Surrogates (Living Will) ES
Form 8647, Service Coordination Assessment – Intellectual Disability Services
Form 8665-ID, Individual Data
Form 8602, Code of Ethics
Form 8658, Enhanced Community Coordination (ECC) Designated Funds Request and Authorization
Form 8619, State Long-Term Care Ombudsman Program Case Record
Form 8401, Employment First Discovery Tool