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Tion Subject: Provider Letter 10-04 Revised Form 3720 (Application for State License to Operate a Long-Term Care Facility) Effective April 1, 2010, the Department of Aging and Disability Services (DADS) will implement use of the revised Form 3720 (Application for State License to Operate a Long-Term Care Facility). The revised form will be available on the DADS website beginning on March 15, 2010, at http://www.dads.state.tx.us/forms/3720. The new application forms will apply to initial a.

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How to fill out the Form 3720 Hhsc online

Filling out the Form 3720 Hhsc is an essential step for facilities seeking a state license to operate in Texas. This guide provides clear and supportive instructions for completing the form online, ensuring that users can submit their application accurately and efficiently.

Follow the steps to complete the Form 3720 Hhsc online.

  1. Click the ‘Get Form’ button to access the form and open it in your chosen editor.
  2. Begin filling out the front page of the application form, ensuring that you provide accurate information for items 1 to 5, as these have been reformatted for clarity.
  3. For items 6 and 7, detail the ownership and management structures of your facility. Make sure to identify all controlling persons, reflecting any multi-tiered ownership situations.
  4. Complete item 8 by listing any other controlling persons not included in the ownership or management entities.
  5. In item 9, describe the real estate information, indicating ownership, lease arrangements, and any sub-leases connected to the property.
  6. Update item 10 with the necessary disclosure information. If you operate multiple facilities, only include those not licensed by DADS.
  7. Review item 11 to confirm approval from the local fire authority, ensuring the information remains accurate.
  8. In item 12, sign the affidavit attesting to the completeness and accuracy of your application.
  9. Once you have filled in all sections, save any changes made to the form. You can then download, print, or share the completed document as needed.

Begin completing your Form 3720 Hhsc online today to ensure a smooth application process.

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A Type B facility is for residents who require staff assistance to evacuate, are not capable of following directions in an emergency and require nighttime attendance.

Becoming Licensed in Texas Complete the pre-survey, computer-based training and submit a copy of the certificate of completion (ALFs only). Properly complete and submit the license application. Submit all required documents. Pay the required license fee. Submit appropriate ownership documents, if applicable.

Prepare for licensure exams To be eligible to take the exam, HHSC requires that you have: A completed bachelor's degree. 15 academic credit hours in Long Term Care Administration. 12 hours, including a 1,000-hour internship in an approved long-term care facility.

Have at least one year (2,000 hours) work experience as an assisted living community executive director OR at least three years (6,000 hours) work experience in a management capacity in one or more assisted living communities and. Pass the certification examination for assisted living community executive directors.

To become licensed, a location must: Complete the pre-survey, computer-based training and submit a copy of the certificate of completion (ALFs only). Properly complete and submit the license application. Submit all required documents. Pay the required license fee. Submit appropriate ownership documents, if applicable.

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