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.
