Criminal history check 2026

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The document is a licensure form for Home and Community Support Services Agencies in Texas, specifically focusing on the Criminal History Check. It requires detailed personal information about agency owners, administrators, and financial officers, including names, dates of birth, race/ethnicity, sex, and social security numbers. The form certifies the accuracy of the provided information and outlines submission guidelines to the Texas Department of Aging and Disability Services for initial applications, renewals, and management changes.

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Click ‘Get Form’ to open the Criminal History Check in the editor.
Begin by entering the Agency Name and Current License Number at the top of the form. Ensure accuracy as this information is crucial for identification.
Fill in the Physical Address, including Street Name, City, State, and ZIP Code. This helps in verifying your agency's location.
Provide your Area Code and Telephone Number for contact purposes.
Complete all applicable fields for Owner Name, Administrator, Chief Financial Officer, and any Other Names Used. Use an addendum if necessary for additional aliases.
Enter Date of Birth (mm/dd/yyyy), Race/Ethnicity, Sex, and Social Security Number for each individual listed.
Finally, certify that all information is true by signing and dating the form before submission.

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Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (122 Votes)

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