Form 5872, Certification of Pre-Application Orientation | Texas Health and Human Services
Purpose Form 5872 is completed by individuals and organizations applying to contract with the Texas Health and Human Services Commission (HHSC) to confirm they read the Pre-Application Orientation Guide required for the following contracts: Community Living Assistance and Support Services (CLASS) Day Activity and Health Services (DAHS) Primary Home Care/Family Care/Community Attendant Services (PHC/FC/CAS) Procedure Form 5872 is prepared for a new contract. Form Retention Contact Administration Handbook. Carefully read the instructions. Errors and omissions will cause delays in processing For...
Source: texas.gov