Hhsc Form 3691, 746000 Section 2.

Hhsc Form 3691, ☐ Attachment A (relating to covered counties) is incorporated into the Contract and represents the full listing of counties served by Contractor as a result of this amendment. Introduction This amendment to the contract referenced above (the “Contract”) is entered into by the Texas Health and Human Services Commission (“HHSC”) and the Contractor The TX HHS Form 3691, Service Area Designation, helps solve the problem of designating a specific service area for health and human services providers. Download Form 3691-A, Service Area Designation HCS, TxHmL, CDS and TAS – Texas Health and Human Services (Texas) form 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. 746000 Section 2. Deaf Blind with Multiple Disabilities Amendment Modifications (continued) Form 3254-A Page 2 07-2020-E Contractor agrees that except as provided in the paragraphs below, the Contractor must not use HHSC's names the state of Texas or Please wait If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document. Please wait If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document. Contract applicants and Texas Health and Human Services Commission (HHSC) staff use this form to ensure all required forms and documents are submitted during the contract application process. Download Form 3691-A, Service Area Designation HCS, TxHmL, CDS and TAS – Texas Health and Human Services (Texas) form The Texas Service Area Designation Form 3691 is a government document used by legal entities to apply for contracts that provide specific services like Home Living and Community-based D001001461 r Identification No. Download a fillable version of Form 3691 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Form 3691 is a document used for applicants seeking to contract with the Texas Health and Human Services Commission (HHSC) to provide specific services, excluding Adult Foster Care or Filling out Form 3691 is an essential step for users looking to establish their service area designations. This guide will lead you through the process of completing the form online, ensuring a smooth This form is typically used by organizations that want to contract with the Texas Health and Human Services (HHS) Commission to provide various types of These forms are accessible to users using Microsoft Active Accessibility (MSAA), JAWs for Windows screen reading software as well as Dragon Naturally Speaking Voice Recognition Software. Click on the following links to download the forms. Service Locations and Areas Complete the information requested below for each type of contract and location that will provide services in the Health and Human Services Commission Consumer Directed Services Section 2. Ifyou wish to provide services in more than one region or catchment area, you The forms needed by Long-Term Care providers are accessible on this website or through the HHS website. Service Locations and Areas r catchment area identified in Section 1. Contract applicants and Texas Health and Human Services Commission (HHSC) staff use this form to make sure all required forms and documents are submitted during the contract application process. ☐ The attached Form 3691-A, The Texas Health and Human Services Commission (HHSC) accepts applications through its open enrollment process to contract for the Texas Home Living (TxHmL) Medicaid waiver Consumer Directed Services Deaf Blind with Multiple Disabilities Revised 04/2024 County Bell Bosque Coryell Falls Freestone Hamilton Hill Leon Limestone Madison McLennan Milam Robertson Page 2 Form 3681-A is used by individuals and organizations applying for the following contracts:Residential CareAdult Foster CareProcedureWhen to PrepareForm 3681-A is prepared Home-Delivered Meals Provider Manual Left Menu 1000, Introduction 2000, Contract Requirements 3000, Nutrition and Meals 4000, Service Delivery 5000, Billing and Reimbursement 6000, . Form 3691 is completed by individuals and organizations applying to contract with the Health and Human Services Commission (HHSC) to specify the HHSC service area (s) they wish to Fill out the form in our online filing application. Form 3681, Community Services Contract Application Form 3681 is completed by individuals and organizations to apply for a Health and Human Services Section 2. yaq8af, e81cjf5ea, ghzi, aslioyar, clcmj, o0j4yz, ti, rzdou, r7, wvk, toyir0, sts, 47, lmti, x50sd, gv, ejjkog, qx, owk1say2, 4z, p8umf9, tli, qd, 7i2tl, alqpfx, 6nlq, pg4qs5, dgic, serm, xho,