The forms listed in this section are available on the department's
website. The department adopts and incorporates by reference the forms
listed in paragraphs (1) - (19) of this subsection, and their use
is required, where applicable, for compliance with the provisions
of this chapter. Forms that are on the department's letterhead will
use the most current version of that letterhead, as it may change
from time to time. Bracketed information in the forms is subject to
change, including the department's physical, mailing, and electronic
addresses; submission locations; submission formats and methods; and
contact information. Persons submitting the forms should verify that
they are using the most recent online version before submitting.
(1) CCRC Form 1 (FIN382)--Application for certificate
of authority to do business in the State of Texas under Health and
Safety Code Section 246.022;
(2) CCRC Form 1a (FIN604)--Application for authority
to offer continuing care in residence in Texas under Health and Safety
Code Section 246.0025(b);
(3) CCRC Form 2 (FIN383)--Application for Commissioner
approval to release excess loan reserve escrow fund amounts under
Health and Safety Code Section 278.078;
(4) CCRC Form 3 (FIN384)--Officers and directors page;
(5) CCRC Form 4 (FIN385)--Biographical data form;
(6) CCRC Form 4a (FIN386)--Biographical data form for
not-for-profit CCRC board members;
(7) CCRC Form 5 (FIN387)--Delivery of disclosure statement;
(8) CCRC Form 6 (FIN388)--Format for disclosure statement
for continuing care facility;
(9) CCRC Form 6a (FIN389)--Instructions for preparing
a continuing care retirement community disclosure statement for filing
with the Texas Department of Insurance;
(10) CCRC Form 6b (FIN605)--Format for disclosure statement
for continuing care in residence;
(11) CCRC Form 7 (FIN390)--Change of control statement
for CCRC;
(12) CCRC Form 8 (FIN391)--Certification of changes
to disclosure statement;
(13) CCRC Form 9 (FIN392)--Notice of request to release
entrance fee escrow funds;
(14) CCRC Form 10 (FIN393)--Notice of request to release
funds from the reserve fund escrow account;
(15) CCRC Form 11 (FIN394)--Notice by provider of re-payment
of previously released funds to the reserve fund escrow account;
(16) CCRC Form 12 (FIN395)--Affidavit of re-payment
of previously released funds to the reserve fund escrow account;
(17) CCRC Form 13 (FIN396)--Notice of lien;
(18) CCRC Form 14 (FIN397)--Calculations concerning
conditions; and
(19) CCRC Form 14a (FIN607)--Provider request for release
of continuing care in residence entrance fee escrow funds.
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| Source Note: The provisions of this §33.8 adopted to be effective March 9, 1989, 14 TexReg 986; amended to be effective March 14, 1996, 21 TexReg 1765; amended to be effective April 17, 2019, 44 TexReg 1867 |
