Form 2101 Texas PDF Details

If you are a resident of Texas, you may be interested in learning about Form 2101, which is used to claim certain tax credits. This form can help reduce your taxable income, so it is worth looking into if you are eligible. The instructions for completing the form are available on the Texas Comptroller of Public Accounts website, and you can also find more information about the credit amount and eligibility requirements there. Note that the deadline to file this form is April 15th each year. So if you think you may be eligible for this credit, be sure to submit your application on time!

QuestionAnswer
Form NameForm 2101 Texas
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesCAS, form 2101 dads, dads form 2101, 23a

Form Preview Example

Texas Department of Aging

Form 2101

and Disability Services

July 2013-E

Authorization for Community Care Services

Service Name:

1.

Date

2. Contract Number

3. Type of Authorization

 

 

 

 

1 New

2 Update

3 Terminate

 

 

 

 

 

7.

Individual Name

8. Individual Number

9. 2060 Score

 

 

 

 

 

 

4.Begin Date

10.Priority

5. End Date

6. Term Code

 

 

11. County

12. Agency

 

324

 

 

13. Provider Address

 

 

SERVICE

 

 

 

COPAYMENT

 

 

 

 

 

 

 

 

 

14. RUG

15. Fund Code

16. Group

17. Code

18. Units

19. Unit Type

20. Initial Amount

21. Ongoing Amount

22. % CMPAS Only

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23a. For PAS check one:

 

CAS

 

PHC

 

FC

 

 

 

Check if CDS

CDS

23b. For DAHS check one:

 

Title XIX

 

Title XX

24. Service Items - Personal Assistance Services Only (check all that apply):

01 Bathing

02 Dressing

03 Exercise

25. Comments:

04 Feeding/Eating

06 Grooming/Shaving/Oral Care

07 Routine Hair/Skin Care

08Toileting

10Transfer

11Walking

12Cleaning

13Laundry

14Meal Preparation

15 Escort

16 Shopping

17 Assist with Self-Administered Medication

Authorizing Agents (as applicable)

26.

Case Manager

27. Telephone Number (with area code and extension)

28. Mail Code

 

29. BJN

 

 

 

 

 

 

 

 

30.

Case Manager Address

 

 

 

 

 

 

 

 

 

 

 

 

 

31.

Practitioner

32. Telephone Number (with area code and extension)

33.

License No

34.

Date of Order

 

 

 

 

 

 

 

35.

Nurse

36. Telephone Number (with area code and extension)

37.

Mail Code

38.

BJN

 

 

 

 

 

 

 

 

39.

Nurse Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40. Diagnosis:

Contracted Agency May Complete This Section and Return a Copy to DADS

Service Initiation Date

Schedule

Sunday

Monday

Tuesday Wednesday Thursday

Friday

Saturday

Total Hours

Agency Contact Person

Telephone No. (with area code and ext.)

Comments:

Signature — Agency Representative

 

Date

How to Edit Form 2101 Texas Online for Free

BJN can be filled in online in no time. Just open FormsPal PDF tool to get it done fast. Our team is dedicated to providing you the best possible experience with our editor by consistently adding new functions and improvements. With these updates, using our editor becomes easier than ever! Starting is effortless! All you should do is follow the next easy steps below:

Step 1: Hit the "Get Form" button above. It is going to open up our pdf tool so that you can begin filling out your form.

Step 2: Once you access the file editor, you'll notice the document all set to be filled out. Other than filling out different fields, it's also possible to do other sorts of things with the form, that is putting on any textual content, modifying the initial textual content, inserting illustrations or photos, placing your signature to the form, and a lot more.

It will be straightforward to fill out the form using out detailed guide! This is what you should do:

1. Complete the BJN with a number of major fields. Gather all the important information and be sure absolutely nothing is missed!

Step no. 1 in submitting dads form 2101

2. After the first part is completed, proceed to type in the relevant information in these: Case Manager, Telephone Number with area code, BJN, Case Manager Address, Practitioner, Telephone Number with area code, Nurse, Telephone Number with area code, BJN, Nurse Address, Diagnosis, Contracted Agency May Complete, Schedule, Sunday, and Monday.

Case Manager, Practitioner, and Nurse Address inside dads form 2101

It's easy to get it wrong when filling out your Case Manager, and so ensure that you reread it before you decide to finalize the form.

3. This third part is typically pretty easy, Signature Agency Representative, and Date - all these form fields will need to be filled out here.

dads form 2101 writing process outlined (stage 3)

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