Form 4121, Home and Community-based Services Texas-2025

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4.3 out of 5

41 votes

Form 4121 is a documentation template used for recording services provided under Home and Community-based Services in Texas, specifically for Community First Choice Personal Assistance Services and Habilitation. It includes sections for individual details, service dates, times, activities of daily living, staff signatures, billable units, and codes for various services provided. The form aims to ensure accurate tracking and reporting of personal assistance services.

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Versions	Form popularity	Fillable & printable
2022	4.3 Satisfied (41 Votes)
2015	4 Satisfied (40 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I send documents to Texas Health and Human Services?

Uploading your files may help us review your case faster. Online: Click here to see instructions on how to upload documents online. You can also send us copies by: Fax: 1-877-447-2839 (toll-free). Write your Social Security number on each item. Mail: HHSC. P.O. Box 149027. Austin, TX 78714-0927.

What is the in home supportive services IHSS program in Texas?

The In-Home and Family Support program provides direct grant benefits to people with physical disabilities and/or their families to choose and purchase services that help them to remain living in their own homes.

How to apply to Texas community care for aged and disabled?

To begin the application process for Community Care for the Aged and Disabled / Community Care Services Eligibility (CCSE), contact your local Aging and Disability Resource Center (ADRC). One can also contact the ADRC at 855-937-2372. One may learn more about these programs by reviewing the online handbook.

What is the fax number for HHSC Texas?

Return the form by To send this back to us, you can either: (a) give it to the employee listed above, (b) mail it in the pre-paid envelope, or (c) fax it to 1-877-447-2839.

How do I upload documents to Texas Health and Human Services?

0:18 2:13 From the document. Center click upload a document to get started. Now enter a few details about theMoreFrom the document. Center click upload a document to get started. Now enter a few details about the document. This helps to process the document faster.

Can I email Texas Health and Human Services?

For questions regarding: State or federal regulations or regulatory policy, call 512-438-3161 or email PolicyRulesTraining@hhsc.state.tx.us . Contracting to provide services and receive reimbursement, call 512-438-3234 or email IDDWaiverContractEnrollment@hhsc.state.tx.us .

What is home and community based services in Texas?

The Home and Community-based Services program provides individualized services and supports to persons with intellectual disabilities who are living with their family, in their own home or in other community settings, such as small group homes.

How do I confirm my identity on Your Texas Benefits?

To confirm your identity: Select Manage, and under Confirm your identity, select Confirm. You confirmed your identity, but you need to add your case to your account.

Form 4121, Home and Community-based Services Texas-2025

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The easiest way to modify Form 4121, Home and Community-based Services Texas in PDF format online

See more Form 4121, Home and Community-based Services Texas versions

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Got questions?

How do I send documents to Texas Health and Human Services?

What is the in home supportive services IHSS program in Texas?

How to apply to Texas community care for aged and disabled?

What is the fax number for HHSC Texas?

How do I upload documents to Texas Health and Human Services?

Complete this form in 5 minutes or less

People also ask

Can I email Texas Health and Human Services?

What is home and community based services in Texas?

How do I confirm my identity on Your Texas Benefits?

Related links

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Form 4121, Home and Community-based Services Texas-2025

Here's how it works

The easiest way to modify Form 4121, Home and Community-based Services Texas in PDF format online

See more Form 4121, Home and Community-based Services Texas versions

Complete this form in 5 minutes or less

Got questions?

How do I send documents to Texas Health and Human Services?

What is the in home supportive services IHSS program in Texas?

How to apply to Texas community care for aged and disabled?

What is the fax number for HHSC Texas?

How do I upload documents to Texas Health and Human Services?

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People also ask

Can I email Texas Health and Human Services?

What is home and community based services in Texas?

How do I confirm my identity on Your Texas Benefits?

Related links

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