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DocuSign Envelope ID: 60F4927E7987495A8F3A0ACCE9B6959AHHSC Contract No. HHS000134800001SIGNATURE DOCUMENT FOR TEXAS HEALTH AND HUMAN SERVICES COMMISSION UNDER THE SPECIAL SERVICES TO PERSONS WITH
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Obtain the special services to persons form from the designated agency or organization.
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Fill out the form completely with accurate information regarding the individual requiring special services.
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Who needs special services to persons?

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Individuals with disabilities who require accommodations or assistance to access services or facilities.
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Elderly individuals who need special care or support due to physical limitations or health conditions.
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Persons with special medical needs or conditions that require specific services or assistance.
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Special services to persons refer to accommodations, modifications, or assistance provided to individuals with disabilities to ensure equal access and opportunity.
Organizations, businesses, or entities that provide services to individuals with disabilities are required to file special services to persons.
Special services to persons should be filled out by providing detailed information on the accommodations, modifications, or assistance provided to individuals with disabilities.
The purpose of special services to persons is to ensure that individuals with disabilities have equal access and opportunities to services and programs.
Information such as the types of accommodations provided, the number of individuals served, and the impact of the services must be reported on special services to persons.
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