Item 24, Service Items, is for Personal Attendant Services only: check all that apply.
Authorizing Agents: as applicable, Caseworker, Practitioner, Nurse.
Contracted agency: a contracted agency may complete its section and return a copy to HHSC.
For PAS: CAS PHC FC Check if CDS. For DAHS: Title XIX Title XX.
| Question | Answer |
|---|---|
| Form Name | Form 2101 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 72 |
| Avg. time to fill out | 12 min |
| Edition | June 2026 |
| Other names | 2101, Form 2101, 2101 form, Form 2101 Texas, Authorization for Community Care Services |
| Official source | Form 2101 (June 2026), Authorization for Community Care Services |
Form 2101 Texas isn’t the one you’re looking for?