TX HHS 3625 2003 free printable template

Texas Dept. of Aging and Disability Services Form 3625 February 2003 Community Living Assistance and Support Services Documentation of Services Delivered 1. Service Month and Year Section A Participant Information 2. Participant Name 3. Medicaid No* 4. Social Security No* for applicants only Section B Provider Agency Information 5. Agency Type CMA 6. Agency Name 7. Vendor No* DSA Section C Pre-Enrollment Assessment Fees CMA/DSA 8. Case Management Services Full Assessment 9. DSA Services...

How to fill out TX HHS 3625

How to fill out TX HHS 3625

1. Begin by downloading the TX HHS 3625 form from the official Texas Health and Human Services website.
2. Fill in your personal information at the top of the form, including your name, address, and contact details.
3. Provide details about your household members and their relationship to you.
4. Indicate your income sources and amounts for the past month, including any wages, benefits, or other financial support.
5. Add any additional information related to your expenses, such as rent, utilities or medical costs.
6. Review the form for accuracy and completeness.
7. Sign and date the form at the designated area to verify the information provided.
8. Submit the completed form to your local Texas Health and Human Services office as instructed.

Who needs TX HHS 3625?

1. Individuals or families seeking assistance or benefits from Texas Health and Human Services.
2. Persons who need to report income and household information for eligibility evaluation for various programs.
3. Applicants for medical, food, and financial assistance programs in Texas.

Instructions and Help about TX HHS 3625

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People Also Ask about

Is Texas Health and Human Services a state agency?

Texas Health and Human Services now consists of 2 agencies: the Texas Health and Human Services Commission and the Texas Department of State Health Services (DSHS). HHS is headquartered in Austin, TX.

Who is eligible for Texas health benefits?

To be eligible for Texas Medicaid, you must be a resident of the state of Texas, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

What is the food stamp interview number Texas?

Staff can access the service by calling 1-800-375-1184 and using their 11-digit employee identification number.

How do I contact my Texas benefits?

Call 2-1-1 or 877-541-7905 (after you pick a language, press 2)

What is the maximum income to qualify for Texas Medicaid?

Who is eligible for Texas Medicaid? Household Size*Maximum Income Level (Per Year)1$26,9092$36,2543$45,6004$54,9454 more rows

What is the monthly income limit for Medicaid in Texas?

888-388-6332 or 512-438-4313 or the relay service of your choice.

What two agencies make up Texas Health and Human Services Commission?

Texas Health and Human Services (HHS) HHS consists of two departments: The Health and Human Services Commission (HHSC); and the Department of State Health Services (DSHS).

What is the highest income to qualify for Medicaid?

Income Limit in Most States Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.

How do I talk to someone at Texas food stamps?

HHS works with federally qualified health clinics, medical associations, community partners and local governments to help clients find the health care they need. Aging and Disability Resource Centers can help Texans find personal care, nursing care, help at home and other long-term care services.

What does the Texas Health and Human Services do?

HHS works with federally qualified health clinics, medical associations, community partners and local governments to help clients find the health care they need. Aging and Disability Resource Centers can help Texans find personal care, nursing care, help at home and other long-term care services.

What is the phone number for your Texas Benefits?

How do I get help filling out my application? Get help over the phone by calling 2-1-1 or 1-877-541-7905. After you pick a language, press 2. Get help in person by clicking the link 'Find an office' at the bottom of any page.

What is the Medicaid income limit for 2022 in Texas?

*If the care recipient has gross countable income greater than $2,523, he or she will be deemed ineligible for Medicaid benefits.

How do I talk to a real person at Texas Health and Human Services?

888-388-6332 or 512-438-4313 or the relay service of your choice.

How do I contact Texas Medicaid by phone?

Phone. Call toll-free at 800-252-8263, 2-1-1 or 877-541-7905. Choose English or Spanish. Choose option 2.

What time does 211 Texas Open?

2-1-1 Texas is a free, anonymous social service hotline available 24 hours a day, 7 days a week, 365 days a year. No matter where you live in Texas, you can dial 2-1-1, or (877) 541-7905, and find information about resources in your local community.

How do I talk to a real person at Texas Health and Human Services?

$104,679. The estimated total pay for a Attorney at Texas Health and Human Services Commission is $104,679 per year.

What is the 1 800 food stamp number Texas?

If you get SNAP benefits: If it doesn't work, call 800-777-7328.

How do I file a complaint against Texas Health and Human Services?

Call 866-566-8989 8 a.m. to 5 p.m. Central Time, Monday through Friday and speak to someone that day.

Can adults qualify for Medicaid in Texas?

Adults with disabilities who qualify will get Medicaid for the Elderly and People with Disabilities. If you have a disability and work, you might be able to get the Medicaid Buy-In for Adults program.

What is the Texas Health and Human Services?

$177,704. The estimated total pay for a Director at Texas Health and Human Services Commission is $177,704 per year. This number represents the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users.

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What is TX HHS 3625?

TX HHS 3625 is a form used by the Texas Health and Human Services to report various health data and information relevant to public health initiatives.

Who is required to file TX HHS 3625?

Entities that provide healthcare services in Texas, including healthcare facilities and providers, are typically required to file TX HHS 3625.

How to fill out TX HHS 3625?

To fill out TX HHS 3625, complete the form by providing accurate information as required, including specific data points relevant to the reporting criteria, and submit it to the appropriate Texas Health and Human Services department.

What is the purpose of TX HHS 3625?

The purpose of TX HHS 3625 is to collect essential health-related data that assists in monitoring public health trends and informing policy decisions.

What information must be reported on TX HHS 3625?

TX HHS 3625 requires reporting of various data points, including patient demographics, types of services provided, and any relevant health indicators or outcomes.