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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 3621-T
for the current year.
Form 3621-T Ipc Service Delivery Transfer Worksheet - Community Living Assistance and Support Services (Class) / Community First Choices (Cfc) - Texas
What Is Form 3621-T?
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 3621-T?
A: Form 3621-T is the IPC Service Delivery Transfer Worksheet for Community Living Assistance and Support Services (Class) and Community First Choices (CFC) in Texas.
Q: What is the purpose of Form 3621-T?
A: The purpose of Form 3621-T is to facilitate the transfer of services for individuals receiving Community Living Assistance and Support Services (Class) or Community First Choices (CFC) in Texas.
Q: Who should use Form 3621-T?
A: Form 3621-T should be used by individuals receiving Community Living Assistance and Support Services (Class) or Community First Choices (CFC) in Texas who want to transfer their services.
Q: Are there any fees associated with submitting Form 3621-T?
A: No, there are no fees associated with submitting Form 3621-T.
Q: What information is required on Form 3621-T?
A: Form 3621-T requires information about the individual receiving services, the current service provider, the new service provider, and the reason for the transfer.
Q: Is there a deadline for submitting Form 3621-T?
A: There may be a deadline for submitting Form 3621-T, so it is best to check with the Texas state agency for the specific timeline.
Form Details:
- Released on February 1, 2022;
- 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 3621-T by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
Download Form 3621-T Ipc Service Delivery Transfer Worksheet - Community Living Assistance and Support Services (Class) / Community First Choices (Cfc) - Texas
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