| Number |
Title |
| 4002 |
Management of Personal Funds and Payment for Support, Maintenance and Treatment
|
| 4002-S |
Management of Personal Funds and Payment for Support, Maintenance and Treatment (Spanish) |
| 4017 |
Capacity Assessment Instrument |
| 4041-B |
Brenham State Supported Living Center Petty Cash Withdrawal Request
|
| 4100 |
Money Receipt |
| 4102 |
Contract/Application for Travel Advance |
| 4105 |
Airline Reservation Request |
| 4108 |
Direct Deposit Authorization |
| 4108-PNA-S |
Direct Deposit Authorization For Personal Needs Allowance Recipients (Spanish) |
| 4109 |
Application for Texas Identification Number |
| 4110 |
Payee Change Request |
| 4116 |
State of Texas Purchase Voucher |
| 4116-Dental |
Dental Summary Sheet |
| 4116-DME |
ICF/IID Durable Medical Equipment Summary Sheet |
| 4116-MHM-AA |
Minor Home Modification/Adaptive Aids Summary Sheet |
| 4117 |
Supported Employment/Employment Assistance Service Delivery Log |
| 4118 |
Respite Service Delivery Log |
| 4119 |
Residential Support Services (RSS) and Supervised Living (SL) Service Delivery Log |
| 4120 |
Day Habilitation Service Delivery Log |
| 4121 |
Supported Home Living/Community Supports |
| 4122 |
Foster/Companion Service Delivery Log |
| 4122-S |
Foster/Companion Service Delivery Log (Spanish) |
| 4123 |
Nurse Services Delivery Log - Billable Activities |
| 4158 |
Statement of Responsibility |
| 4183 |
Authorization for Use of State Aircraft |
| 4222 |
HUB Best Practices Clause for Vendor Contracts |
| 4223 |
HUB Subcontracting Plan, Applicant Status Determination |
| 4224 |
HUB Subcontracting Plan, Subcontractor Status Determination for Vendor and Grant Contracts |
| 4225 |
HUB Best Practices Clause for Grant Contracts, Including Grant Requests for Proposals |
| 4226 |
Grant Contract Applicants HUB Subcontracting Plan (HSP) |
| 4227 |
Grant Contract Applicants HUB Subcontracting Plan (HSP) Determination of Good Faith Effort for Grant Contracts |
| 4228 |
Grants Contract HUB Subcontracting Plan (HSP) Quarterly Subcontract Report for Grant Contracts |
| 4719 |
Fire Drill Report |
| 4732 |
Nongovernmental Contractor Certification |
| 4732-A |
Nongovernmental Contractor Certification (Part II) |
| 4800-D |
DADS Fair Hearing Request Summary |
| 4800-DA |
4800-D Addendum |
| 4807-D |
DADS Action Taken on Hearing Decision |
| 4880 |
Affidavit Concerning Payment of Child Support |
| H4100 |
Money Receipt |
| H4116 |
State of Texas Purchase Voucher |
| H4701 |
HHSC Out Card |
| H4744 |
Batch Control Sheet |
| H4745 |
Batch Control Ledger |
| H4800 |
Fair Hearing Request Summary |
| H4800-A |
Fair Hearing Request Summary (Addendum) |
| H4803 |
Notice of Hearing |
| H4803-P |
Notice of Hearing |
| H4803-T |
Notice of Hearing |
| H4803-TS |
Notice of Hearing (Spanish) |
| H4804 |
Request and Authorization for Fair Hearing Record to Remain Open |
| H4805 |
Fair Hearing Procedures |
| H4806 |
Request for Another Appointment - Request to Withdraw |
| H4807 |
Action Taken on Hearing Decision |
| H4808 |
Notice of Change in Applied Income/Notice of Denial of Medical Assistance |
| H4809 |
Update After Fair Hearing Data Entry Form |
| H4810 |
Waiver of Notice of Fair Hearing |
| H4811 |
Confirmation of Verbal Request to Cancel Appeal |
| H4827 |
Withdrawal of Appeal Request |
| H4831 |
Fraud Referral Log |
| H4833 |
Appeals Information |
| H4837 |
Fair Hearings Evidence Packet Cover Letter |
| H4851 |
Notice of Administrative Disqualification Hearing |
| H4851-C |
Notice of Administrative Disqualification Hearing |
| H4851-P |
Notice of Administrative Disqualification Hearing |
| H4851-T |
Notice of Administrative Disqualification Hearing |
| H4855 |
Statement of Household Member's Rights in Administrative Disqualification Hearing
|
| H4855-S |
Statement of Household Member's Rights in Administrative Disqualification Hearing (Spanish)
|
| H4856 |
Request for Another Appointment for Administrative Disqualification Hearing |
| H4857 |
Notice of Decision, Administrative Disqualification Hearing |
| H4861 |
Receipt of Notice |
| H4870 |
Client Complaint of Discrimination (English-Spanish Version) |