№ files_lp_3_process_7_061429
Administrative application form and procedural instructions issued by DFPS outlining eligibility criteria, required documentation, regional service designation, and certification requirements for entities seeking enrollment to provide hospital sitting services in Texas.
Year: Not specified
State: Texas
Country: United States
Program: Hospital Sitting Services Open Enrollment
Administering Agency: Department of Family and Protective Services (DFPS)
Document Type: Open Enrollment Application Form and Submission Instructions
Application Requirement: Completed and signed Section 4 (Certification)
Submission Method: Electronic submission by email with File Folder 1 and File Folder 2 attachments
Eligibility Criteria: Two years of full-time relevant service management experience; two years of relevant financial management experience; compliance with insurance requirements in Section 2.15
Service Delivery Area: DFPS Regions 1–11 in Texas
Required Attachments: Insurance documentation; Assumed Name Certificate (if applicable); Certificate of Incorporation (if applicable); LLC Articles of Formation (if applicable); Partnership Agreement and partner list (if applicable); HUB Certification (if applicable)
Required Forms: Vendor Direct Deposit Form (74-176); Internal Control Structure Questionnaire (9007FFS); Risk Analysis Questionnaire (9105RAQ); Application for Texas Identification Number (AP-152); Signature Authority Designation (2031); PCS-102 Contracting Entity and Staff List; Disclosure and Consent to Release of Information (2970C); Request for Criminal History and DFPS History Check (2971C)
Certification Requirement: Signature of Authorized Representative confirming accuracy and compliance
Target Applicants: Sole Proprietorships; Private Corporations; Non-Profit Organizations; Limited Liability Companies; Partnerships; Governmental Entities
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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