Hhsc form 4732

Advance Directives Health and Human Services Forms. Texans can dial 2-1-(option 6) for information on COVID-and local resources on health care, utilities, foo housing and more. If you have any difficulty viewing any page with adaptive technology, please contact the webmaster for this site, or the HHS Forms Coordinator. Department of Family and Protective Services, Policy Handbooks.

Previous Page Next Page. A guardian is a person or entity appointed by the probate court to have full or limited authority over an incapacitated person, depending on the incapacitated person’s specific mental or physical limitations. Section of this form will be forwarded to a financial institution outside the United States. Section 6: Authorization for Setup, Changes or Cancellation Must be completed in its entirety, and no alterations to the authorization language will be.

A full and accurate disclosure of ownership and control interest is required. See full list on hhs. If an individual, enter the individual’s full legal name. Name of Contact Person– Enter the name of the person who can answer questions about the information furnished on the form.

Area Code and Fax No. Email Address – Self-exp. The disclosing entity is required to fully disclose all levels of ownership of or more, and to fully disclose all entities and all individuals at each level of ownership, from the ownership of the disclosing entity to the ownership of each successive ownership entity. The or more ownership interest may be direct, indirect or a combination of direct and indirect ownership interest. Direct ownership interest is defined as the possession of stock, equity in capital or any interest in the profits of the disclosing entity.

Indirect ownership interest is defined as ownership interest in an entity that has direct or indirect ownership interest in the disclosing entity. The amount of indirect ownership in the disclosing entity that is held by any other entity is determined by multiplying the percentage of ownership interest at each level. An indirect ownership must be reported if it equates to an ownership interest of or more of the disclosing entity.

Example:If A owns of the s. Otherwise, check the NA box, leave sections 4-blank and go to Section 7. For example, for profit-corporation, limited partnership, limited liability company, etc. Business Entity Type– Enter the applicable business entity type. Employer Identification Number (EIN)– Enter the federal employer identification number (EIN) assigned to the management company by the IRS. Physical Address (Street, City, State, ZIP Code)– Self-explanatory.

Mailing Address (P.O. Box or Street, City, State, ZIP Code)– Self-explanatory. The disclosing entity is also required to disclose all managing employees at each level of ownership. Complete this section if Section was completed. First, list business entities with a or more ownership interest in 5. Then, list individuals with a or more ownership interest in 5. If additional entries are required for full disclosure, copy this section and include as an attachment.

If both questions are answered Yes, provide the requested information. Note:A secured obligation with a business entity that is a financial institution regulated by a federal or state governmental agency does not have to be disclosed. If any question is answered Yes, provide the information requested. A judgment of conviction has been entered against an individual or entity by a federal, state or local court, regardless of whether: 1. An individual or entity has entered into participation in a first offender, deferred adjudication or other program or arrangement where judgment of conviction has been withheld.

Specific Instructions Enter your social security number as it appears on your social security card. Form PCS 10 Contracting Entity and List of Staff, Subcontractors, and Volunteers. An RDN is an attribute with an associated value in the form attribute=value;. Event Viewer automatically tries to resolve.

Click on Forms and Publications Follow the links to specific materials, or find them by typing the publication number into the search box at the top of the web page. Publication 1 Your Federal Income Tax For Individuals, covers the general rules for filing a federal income tax return. Knives and plates, available at extra cost, are not included with the chopper. We are currently experiencing a higher than normal call volume.

We are working diligently to meet the needs of our customers while balancing the needs of our employees. DFPS cannot provide legal advice to members of the public regarding the use of this form.