Form 5872, Certification of Pre-Application Orientation | Texas Health and Human Services

Purpose
Form 5872 is completed by individuals and organizations applying to contract with the Texas Health and Human Services Commission (HHSC) to confirm they read the Pre-Application Orientation Guide required for the following contracts:
Community Living Assistance and Support Services (CLASS)
Day Activity and Health Services (DAHS)
Primary Home Care/Family Care/Community Attendant Services (PHC/FC/CAS)
Procedure
Form 5872 is prepared for a new contract.
Form Retention
Contact Administration Handbook.
Carefully read the instructions. Errors and omissions will cause delays in processing Form 5872.
Legal Entity Information
Legal Entity Name — Enter the full, legal name of the entity, exactly as it was chartered, filed, registered or otherwise legally declared.

Related Keywords

Texas ,United States , ,Contact Administration Handbook ,Business Organization ,Community Living Assistance ,Texas Health ,Health Services ,Authority Resolution ,Home Care Family Community Attendant Services ,Human Services Commission ,Pre Application Orientation Guide ,Living Assistance ,Support Services ,Community Attendant Services ,Contact Administration ,Completing Form ,Entity Name ,Entity Signature ,Governing Authority Resolution ,Governmental Entity ,Texas Health And Human Services ,டெக்சாஸ் ,ஒன்றுபட்டது மாநிலங்களில் ,வணிக ஆர்கநைஸேஶந் ,சமூக வாழும் உதவி ,டெக்சாஸ் ஆரோக்கியம் ,ஆரோக்கியம் சேவைகள் ,மனிதன் சேவைகள் தரகு ,வாழும் உதவி ,ஆதரவு சேவைகள் ,நிறுவனம் பெயர் ,அரசு நிறுவனம் ,டெக்சாஸ் ஆரோக்கியம் மற்றும் மனிதன் சேவைகள் ,