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This version of the form is not currently in use and is provided for reference only. Download this version of
Form 3613-A
for the current year.
Form 3613-A Snf, Nf, Icf / Iid, Alf, Dahs and Ppecc Provider Investigation Report With Cover Sheet - Texas
What Is Form 3613-A?
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 3613-A?
A: Form 3613-A is a provider investigation report used in Texas.
Q: What types of facilities does Form 3613-A cover?
A: Form 3613-A covers SNF (Skilled Nursing Facilities), NF (Nursing Facilities), ICF/IID (Intermediate Care Facilities for Individuals with Intellectual Disabilities), ALF (Assisted Living Facilities), DAHS (Day Activities and Health Services), and PPECC (Prescribed Pediatric Extended Care Centers).
Q: What is the purpose of Form 3613-A?
A: Form 3613-A is used for conducting investigations of providers in various types of facilities in Texas.
Q: Is Form 3613-A accompanied by a cover sheet?
A: Yes, Form 3613-A is accompanied by a cover sheet.
Form Details:
- Released on August 1, 2021;
- 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 3613-A by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
Download Form 3613-A Snf, Nf, Icf / Iid, Alf, Dahs and Ppecc Provider Investigation Report With Cover Sheet - Texas
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