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Contract-Related Forms

Texas HHS Foster Care Ombudsman: English / Spanish

Form Number Form Name
  Contractor Information
1105 Intense Psychiatric Transitional Program Discharge Notice
1106 Intense Psychiatric Transitional Program Discharge Notice Communication
2031 Signatory Authority Designation
2033RCC Subcontractor Documentation Form
2033a-RCC Subcontractor Process (PDF Document)
2069 Caregiver Declaration for International Travel Form (PDF Document)
2085E Education Decision-Maker Form
2128 24 Hour Awake Caregiver Supervision Plan
2109 Residential Child Care Discharge Notice Form
2279b Certification of Receipt of Child Sexual Abuse or Sexual Aggression Information
2403 Medical, Dental, Vision, Hearing, or Behavioral Health Appointment / Instructions
2500 Transition Plan Form & Instructions
2530 CPS Rights of Children and Youth in Foster Care
2530s Derechos de los niños y jóvenes en régimen de acogida de CPS
3300 Single Child's Plan of Service / Instructions
PCS-102 PCS Background Checks
9007RCC Internal Control Structure Questionnaire (ICSQ) for Residential Child Care

Supervised Independent Living (SIL) Forms

Form Number Form Name
PCS-101SIL Contractor Information Form
PCS-102SIL Contracting Entity and List of Staff, Subcontractors, and Volunteers
2609-AP Supervised Independent Living Physical Setting Walk Through Check List- Apartment Setting
2609-CD Supervised Independent Living Physical Setting Walk Through Check List- College Dorm Setting
2609-NCD Supervised Independent Living Physical Setting Walk Through Check List- Non-College Dorm Setting
2609-HH Supervised Independent Living Physical Setting Walk Through Check List- Host Home Setting
2609-SH Supervised Independent Living Physical Setting Walk Through Check List- Shared Housing Setting
2661-SIL Weekly Status Report For Residential Contracts Supervised Independent Living

Medical Consent Forms

Form Number Form Name
2085B Designation of Medical Consenter / Instructions
2094 Summary of Child's Medical Care (PDF Document)
4526 Psychotropic Medication Treatment Consent Form

Other Forms

Form Number Form Name
2069 Caregiver Declaration for International Travel Form
2530 CPS Rights of Children and Youth in Foster Care
2530s Derechos de los niños y jóvenes en régimen de acogida de CPS