Form 3621-T, CLASS/CFC – IPC Service Delivery Transfer Worksheet

Texas Health and Human Services

This government document is issued by Texas Health and Human Services for use in Texas

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File Details: PDF (298 KB)
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Source
https://www.hhs.texas.gov/regulations/forms/3000-3999/form-3621-t-classcfc-ipc-service-delivery-transfer-worksheet

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