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Contract-Related Forms

Texas HHS Foster Care Ombudsman: EnglishPDF DocumentExternal Link / SpanishPDF DocumentExternal Link

Form Number Form Name
  Contractor InformationExcel Spreadsheet
1105 Intense Psychiatric Transitional Program Discharge NoticePDF Document
1106 Intense Psychiatric Transitional Program Discharge Notice CommunicationPDF Document
2031 Signatory Authority DesignationWord Document
2033RCC Subcontractor Documentation FormExcel Spreadsheet
2033a-RCC Subcontractor ProcessWord Document (PDF Document)
2069 Caregiver Declaration for International Travel FormWord Document (PDF Document)
2085E Education Decision-Maker FormPDF Document
2128 24 Hour Awake Caregiver Supervision PlanPDF Document
2109 Residential Child Care Discharge Notice FormWord Document
2279b Certification of Receipt of Child Sexual Abuse or Sexual Aggression InformationWord Document
2403 Medical, Dental, Vision, Hearing, or Behavioral Health AppointmentPDF Document / InstructionsWord Document
2500 Transition Plan Form & InstructionsWord Document
2530 CPS Rights of Children and Youth in Foster CareWord Document
2530s Derechos de los niños y jóvenes en régimen de acogida de CPSWord Document
3300 Single Child's Plan of ServiceWord Document / InstructionsWord Document
PCS-102 PCS Background ChecksExcel Spreadsheet
9007RCC Internal Control Structure Questionnaire (ICSQ) for Residential Child CareWord Document

Supervised Independent Living (SIL) Forms

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

Medical Consent Forms

Form Number Form Name
2085B Designation of Medical ConsenterWord Document / InstructionsWord Document
2094 Summary of Child's Medical CareWord Document (PDF Document)
4526 Psychotropic Medication Treatment Consent FormWord Document

Other Forms

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