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
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Download Form 3621-T Ipc Service Delivery Transfer Worksheet - Community Living Assistance and Support Services (Class) / Community First Choices (Cfc) - Texas