IPC Service Delivery Transfer Worksheet - CLASS Form 3621-T - dads state tx-2026

1. Click ‘Get Form’ to open the IPC Service Delivery Transfer Worksheet in the editor.
2. Begin by entering the individual's name and Social Security number at the top of the form. This information is crucial for identifying the recipient of services.
3. Fill in the IPC Effective Period by specifying the start and end dates in MM/DD/YYYY format. This section indicates when services will be active.
4. Complete the Case Management Agency section, including service codes and categories. Ensure you accurately list all relevant services being transferred.
5. In the Direct Services Agency section, input details such as vendor numbers, units, rates, and estimated costs for each service provided.
6. Review all entries for accuracy before signing. Multiple signatures are required from involved parties to finalize the transfer process.

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