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Form 5010 Enrollment Systems Attestation - Texas
What Is Form 5010?
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 5010?
A: Form 5010 is an enrollment systems attestation form.
Q: What is the purpose of Form 5010?
A: The purpose of Form 5010 is to attest that the enrollment system used by a provider or supplier meets the requirements of the Texas Health and Human Services Commission (HHSC) and that accurate information is being submitted.
Q: Who needs to complete Form 5010?
A: Providers or suppliers who are enrolling in or updating their enrollment information with the Texas HHSC need to complete Form 5010.
Q: What information is required on Form 5010?
A: Form 5010 requires information about the provider or supplier, details about the enrollment system being used, and attestation statements.
Form Details:
- Released on February 1, 2020;
- The latest edition provided by the Texas Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 5010 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
